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THE ADOLESCENT MOTHER mi> HER INFANT: 
CORRELATES OF TRANSACTION AND DEVELOPMENT 



By 

Julie .Anne Hofhei^rier 



A DISSERTAT'ION PPj^SENTED TO THE GR.ADUATE ' C0L':n1CIL 
OF THE UNIVERSITY OF FLORIDA IN 
PARTIAL FULFILLNENT OF THE REQUIREMENTS 
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY- 



UNIVERSITY OF FLORIDA 



1979 



Copyright 1979 
by 

Julie Anne Hofheimer 



This work is lovingly dedicated to my family 
for enduring my never-ending adolescence 
and most especially, for teaching me 
the true meaning of attachment and bonding . . 



J.A.H., 19 



If one is to succeed in leading a man 
to a certain goal, one has to take care 
to find him where he actually is and to 
begin there; to be of real help to a 
person, one must understand more than 
he does, but in the very first place, 
one must understand what he understands. 

Kierkegaarde 



ACKNOWLEDGEMENTS 

Throughout the course of my doctoral work there have been a number 
of individuals who have contributed a great deal. It is with a most 
special appreciation for their sensitivity that I recognize them. 

The author gratefully acknowledges the contributions of Dr. Charles 
Mahan and Ms. Marci Hall of the Department of Obstetrics and Gynecology 
for the support of this study. Appreciation for their cooperation is 
also extended to Drs . Don Eitzman, Michael Resnick and June Holstrum 
of the Division of Neonatology, Department of Pediatrics, These indivi- 
duals offered a great deal of sensitivity to this study of mothers and 
their babies and represent the College of Medicine's humanistic approach 
to the family. 

Of most importance to the author were the continued guidance and 
thoughtful encouragement; the time and care taken in the midst of 
hectic schedules. It is with heartfelt thanks that appreciation is 
extended . 

My chairman. Dr. Athol Packer, has my deepest respect and grati- 
tude for his gentle direction and thoughtful guidance. My thank^, too, 
for his patience in teaching me to reason with feeling and feel with 
reason. Kis consistent support and open-minded faith in me has been 
a most important part of my growth. 

To Dr. Michael Resnick, a special thanks for opening up a whole 
new v/crld and allowing me to dream dreams and make them come true. 
I am appreciative, as well, for being given the freedom to explore. 
It is for all of his creative idealism that I am especially grateful. 



To Br. Patricia Ashton, rxy appreciation fox her irLSight 
in helping me take a step bs-ck and looK at ^otber^v and babies 
from ail perspsctivas , A special -chanks, too, xcr bsir.g 
such a strong inc-del of all thai', is ?oft and feminine, U'hile 
at the same time exenip 1 if y 1 ng s ciio .1 arshi p and prof ess iana lisra . 

To Dr. Jim Algins, my thanks for hi5 intuitive assistance 
in the analysis of my data. I ha\'^!:i especially appreciated 
his ability -to tie up the loos(-j ends and so patiently help 
Lte try to understand some difficult concepts. 

Dr. Bob Soar has been continuously supportiire. His 
sensitive methodological recosimendatiorxs and interpretations 
c£ my analyses are greatly appreciated. 

I would also like to extend my thanks to Drs. Bill 
Ware and Mari.a Llabre for so parieiitly helping Eie look at 
the world analyticaily and with high standards of excellence 
in research. I am grateful for their support of me in sy 
most difficult endeavor and for giving me the confidence 
to persue a new interest. 

To the friends who have staged by my side, I ani 
especially grateful for their f^ith in m3 and their help 
in keeping it all in the proper perspective .... . for the 
tender understanding and, .u-ost of all, for always being there. 



vi 



Tlie following individuals provided assistance throughout, .the 
course of the study. The encouragement and enthusiasm proved instru- 
mental to its success. Their coramittment gave roe the strength to 
cai'ry on and I am most appreciative of their help. 



Kimberly Bounds 
Francis Graves 
Linda Schlosser 
Susan Shome 
Beth McLaurin 
Debbie Roberts 
Beth Clark 
Iinogene Clark 



Maria Frankenfield 
Becky Montevideo 
Lisa Schiavoni 
Bob Rose 

Rutledge Withers 
Susan Mock 
Tess Bennett 
Renec Mi.ller 



My thanks are extended, as well, to the staff of the Pediatric 
Clinic and the Infant Development Project for their encouragement and 
support. 



vii 



TABLE OF CONTENTS 



PAGE 



ACKNOWLEDGEMENTS :.v 

ABSTR/VCT , ix 

CHAPTER 

I. INTRODUCTION 1 

Adolescent Family Development . 2 

The Concept of Parent-Child Transaction and 

Infant Development 4 

Questions Posed by the Study 6 

Summary 7 

11: THE REVIEW OF THE PJESEARCH "■. . 9 

Parent-Child Transaction and Infant Development 10 

Tlie Young Mother and Her Infant 21 

Summary 34 

III. TOE METHODOLOGY 45 

Questions Posed by the Study , 45 

" Definition of Terms 47 

* The Subjects 49 

' The Procedure 50 

' Instrum.entation , 52 

Statistical A.nalyses 57 

Limitations of the Study 62 

Summary 63 

lY. THE RESULTS 64 

The Dimensions of Mother- Infant Transaction 64 

Description of the Sample 74 

Mother's Age^ Perinatal Risk and Socioenvironm.ental , 

Educational and Medical Resources ... S3 

The Prediction of Infant Development 92 

Summary ........... 104 



viii 



TABLE OF CONTENTS - Continued 



PAGE 



V. DISCUSSION AND IMPLICATIONS 106 

The Age of the Mother as a Predictor of 

Infant Uevelopment and Mother-Infant Transaction . . 106 
Prenatal and Perinatal Factors and Socioenviron- 

mental, Medical and Educational Resources 108 

The Prediction of Developmental Risk 

in Infancy . 110 

Mother- Infant Transaction as a predictor 

of Infant Development 112 

Summary and Conclusions 113 

APPENDICES 

A. PARENTS CONSENT 115 

THE ASSESSMENT PROTOCOL 116 

CMLD' AND' '.FAMILY- DEVELOPMENT' 'QUESTIONNAIRE . ... 118 

B. DEFINITIONS OF MOTHER AND INFANT BEHAVIORS .... 120 

C. BAYLES SCALES OF INFANT :DEVEL0PME-NT ■123 

D. PER.INA.TAL 'RISK- SGA.-LB 126 

REFERENCES 131 

BIOGRAPHICAL SKETCH 140 



Abstract of Dissertation Presented to the Graduate Council 
of the University of Florida in Partial Fulfillment of the Requirements 
for the Degree of Doctor of Philosophy 

THE ADOLESCENT MOTHER AND HER INFANT: 
CORRELATES OF TRANSACTION AND DEVELOPMENT 

By 

Julie Anne Hofheimer 
August, 1979 

Chairman: Athol B. Packer 

Major Department: Early Childhood Education 

The increasing number of births to adolescent mothers has prompted 
serious concern by professionals attempting to enhance the quality of 
life for the family. We have reason to believe that the young mother 
and her infant are at risk for problematic development; yet our present 
sources of knoivledge are limited in number and yield inconclusive find- 
ings. The primary purpose of this study was to assess the contributions 
of the mother's age, perinatal risk status, and socioenvironmental , 
medical and educational resources to the prediction of the dimensions of 
the mother-infant transaction process and the developmental status of 
the infant, A second purpose of the study was to ascertain the ability 
of the transaction dimensions to predict the mental and psychomotor 
development of the infant. 

The data v;ere collected in a clinical setting on an age-specific 
sample of 77 mothers and their six months-old infants. The mental and 
psychomotor development of the infant was evaluated using rhe Baylay 
Scales of Infant Development . Mother-infant transaction was analysed 



using the Adapted Beckwith Behavior Scale . Demographic and socioenviron- 
mental data were obtained from the Child and Family Developm ent Interview, 
which was developed for use in this study. 

In order to reduce the number of variables and define the more 
global dimensions of mother-infant transaction, a correlation matrix 
of the 27 variables of the Adapted Beckwith Scale was subjected to a 
principle components analysis. As a result of this analysis, five 
dimensions of mother-infant transaction were defined and each subject's 
composite score was calculated for each of the five rotated components. 

In the first multivariate multiple regression analysis, the 
dimensions of mother-infant transaction and the infant's mental and 
psychomotor developm.ent were considered to be the outcome measures of 
early pregnancy and parenting. These measures were regressed on 
mother's age and education, baby's sex and birth order, yearly income, 
ethnic origin, social support system, perinatal risk status, prenatal 
complications and the type of prenatal care received by the mother. 

The follow-up univariate analyses indicated that the age of the 
mother and the absence of prenatal complications had a positive 
relationship with the infant's mental development. Tae plots of the 
residuals evidenced no deviation from linearity. It was concluded 
that there was a positive linear relationship between these variables 
and the infant's mental development. The type of prenatal care 
received by the mother contributed to the prediction of the infant's 
mental development. Tne follow-up pairwise comparisons of each type 
of prenatal care indicated significantly higher means for infants whose 
mothers received Teenage Pregnancy Team care (com.prehensive services) 
when compared to those groups receiving care from a private physician 



X 



and Shands Teaching Hospital High Risk Clinic (obstetric care only) . 
T^e daXa did not iuppc-^ut tkt kypothUA^i tliat motliz/i-.cnta.iit t'laiuactlcn 
vcxjLLzd <u a ^'Miction o f^ tlie. ago. q{ t'm mot}i2A, 

In order to ascertain the ability of the transaction components 
to predict the development o£ the infant, a second multivariate 
multiple regression analysis was implemented. The dimensions of 
mother-infant transaction were found to contribute a significant 
proportion of shared variance to the infant's psychomotor development. 
The component of transaction which contributed a uniquely significant 
proportion was responsive vocalization. 

Based upon the results of the follow-up univariate analyses, the 
variables which were identified as predictors of mental development 
were: 1) the age of the mother; 2) the type of prenatal care received 
by the mother; and 3) the presence of prenatal complications. Psycho- 
motor development was found to vary as a function of: 1) responsive 
vocalization of the mother-infant transaction process; and 2) the 
t^-^e of prenatal care received by the mother. The regression coef- 
ficents indicated that for each year of mother's age, the infants 
differed, on the average, by 2.6 points on the Mental Development Index 
and by 1.2 points on the Psychomotor Development Index. 

ITie results of this study suggest that the infants of young 
mothers are at risk for problematic development and would benefit 
from early intervention efforts. The data also supported the idea that 
the mother-infant relationship is important to the infant's development 
of competence. Based upon the findings presented in this study, we 
have reason to believe that more comprehensive interdisciplinary 
models of prenatal, perinatal and pediatric support are associated 

xi 



with enhanced development of the infant. These findings suggest 
several considerations for the design of parent and infant-centered 
interventions for the young parent fandly in order to enrich the qual- 
ity of care and stimulation provided by the adolescent mother and 
thus enhance the development of the infant. 



CE4PTER I 
INTRODUCTION 

The emergence of a phenomenal niimber of births to adolescent 
mothers has prompted serious concern by professionals attempting to 
enhance the quality of life for the individual and the family. While 
there exist serveral studies which explore the various aspects of early 
pregnancy and parenting, very little is knovm about the nature of the 
relationship between the adolescent mother and her infant and the 
infant ' s development . 

IVhat are the characteristics of the very young mother how 
do her behaviors differ from or simulate those of her "of age" peer? 
How does she relate to her baby and what are the effects of her style 
of mothering on her baby and the developing family unit? Ansxvers 
to these questions pose a challenge to the researcher and are in need 
of investigation. Such is the task at hand. Most importantly, this 
study attempts to explore the role of the adolescent as a mother in a.n 
effort to understand her strengths and limita-cions and their implicaticns 
for her baby's development. 

It is the purpose of this study, therefore, to examine the 
relationship between infant development and mother-infant transaction 
in the adolescent family. The information obtained as a result of this 
study will assist professionals by increasing their understanding of the 
developmental status of the infant and the parenting style of the young 
mother in order to design more comprehensive programs for the young family. 

1 



2 

The essence of "comprehensive care" involves a thorough under- 
standing of the adolescent undertaking the tasks of early parenthood. 
It is through this understanding that our interdisciplinary efforts 
may become more sensitive to the complex needs of the young mother, 
her infant and her family. The commitment to quality care implies 
a change on the part of the professional comjnunity--a change based on 
empirical evidence which documents the educational and developmental 
competencies and capabilities of the very young mother. By focusing 
on the it.ie.ngtki within the family, our efforts will project a more 
supportive quality. It is this belief in the positive characteristics 
of young parents --courage, enthusiasm, adaptability and, above all, an 
optimistic view of the future--that is the philosophy upon which this 
study is based. 

Adolescent Family Development: The Scope of the Problem 

The threatening impact of early parenthood has become a source of 
great concern in the recent past. In 1976, the Guttmacher Institute 
reported that about 10 percent of ,^erican adolescents become pregn.ant 
each year — one million young women, isinety-four percent of these 
women have chosen to keep their babies, 'vhat happens to these young 
families remains a challenging question. 

The early years of parenthood, even under the most optimal circum- 
stances, are commonly viewed as a transitional period — one in \vhich the 
individual is attempting to establish equilibrium and adjust to the 
responsibilities of becoming a parent; of caring for another hum.an 
life (Ro3si, 1968 ; Packer, Resnick, Wilson . and Resnick, 19:79}. This 
can be an extremely stressful period for all members of the fam.ily. 



3 



The impact of the transition to parenthood on the individuals 
involved as it related to future parent-child transaction has been the 
subject of many current studies, Brazeltcn's (1973) findings suggest 
critical interrelated components through which the mother forms the 
beginning of attachment to the infant. The stages include: 1) plan- 
ning the pregnancy; 2) confirming the pregnancy; 3) accepting the 
pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the 
fetus as an individual; 6) birth; 7} seeing the baby; 8) touching the 
baby; and 9) giving care to the baby. Russell's (1974) examination of 
511 couples and their 6-56 week old infants supports the view that the 
transition to parenthood is a crisis situation which involves a reorga- 
nization of the family's social structure. This change in family 
relationships was noted to be "bothersome" to new parents. Relevant 
adaptational factors noted by Russell from self -report checklists were: 
1) the pattern of communication which affected the planning of the birth 
and a positive adjustment to marriage; 2) a high degree of commitment to 
the parenting role; 3) good maternal health; 4) a nonproblematic baby; 
and 5) preparation for parenthood. These factors are compounded in 
magnitude in the developmental tasks of the adolescent mother. 

Of special concern for the very young mother is her ability to cope 
with the multidimensional aspects of parenthood and to facilitate positive 
transactions with her child. The five factors discussed above suggest 
the need for further exploration as they involve two very specific 
developmental tasks: 1) the adolescent's acquisition of an independent 
concept of self; and 2) the parent's role transition from an individual 
to a member of either a dyad or a triad. W'heji one considers the magni- 
tude of each of these tasks separately and then as occurring simultaneously, 
the situation of the young mother and her baby becomes potentially m.ore 
devastating . 



An area of general concern is the lifestyle chosen by the mother 
and its implications for tlie development of the mother, her baby and the 
developing family unit. Alternatives chosen by the mothers have included 
marrying the father, raising the child alone or living v/ith the extended 
family, relatives or friends. Tne ramifications of the choice of life- 
styles have been the focal point of several studies which have noted the 
"burdens and benefits" of early parenting (Furstenberg, 1978} . Negative 
outcomes ha^^e been related to: 1) a loss of educational and vocational 
skills; 2) family impoverishment due to the high incidence of repeated 
pregnancies in the adolescent population (Moore, 1978); 3) a 60 percent 
divorce rate for pregnant adolescents who marry; 4) a higher degree of 
medical complications and risks during prenatal and neonatal periods for 
mother's lacking in prenatal care (Placek and Jones, 1976); and 5) a 
lack of preparation for the parenting role (Crider, 1976; Badger et al., 
1974) resui tmg in a lack of skills in facilitating parent-child relation- 
ships, as well as a high degree of suspected child abuse (DeLissovoy, 1973). 

The positive outcomes of early parenting are difficult to assess and 
often far more difficult to accept. More staggering than the sheer numbers 
of young mothers and more perplexing than the risks in questions are the 
prevalent attitudes of today's society. T\\e negativism faced by the mother 
in the school, professional" environment and community is potentially 
more devastating than early parenthood itself. In effect, this says to 
the mother, "you can't be a, good mother- -you ■ re too young!" If our 
efforts are to be fruitful, we must open out minds and maintain a realistic 
perspective in order to understand the role of the adolescent as a parent. 

The Concept of Parent-Child Transa ct ion and Infant Development 

The past decade has witnessed considerable research in the area of 
neonatal characteristics with respect to innate competencies and 
capabilities. Vae data indicated that the newborn arrives v\rith two 



5 

sequentially integrated systems of readiness (Gordon, 1975) . The ability 
of the sensor)^ system to receive and the central nervous system to 
process information is referred to as "responsive readiness." From 
this point, "adaptive readiness" allows the infant to cope with and 
modify the environment accordingly. It is this reciprocal relationship 
between the infant and the environment which is described as transaction 
and which forms the base upon which future development and learning grow. 
The attachments formed as a result of these first transactions between 
parent and newborn thus become important to an understanding of 
development . 

Of primary significance to the newborn are those individuals with 
whom the first contact is made and a relationship established — the mother, 
father and other family members. Numerous studies have dealt with the 
implications of these first bonding experiences--Those which establish 
the attachment of one individual to another through the unique exchange of 
sensory stimulation and affective warmth (Ainsworth, 1972; Bell, 1974; 
Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). The use of direct 
and videotaped observations of dyadic interaction has been one useful means 
of exploring the parent-child relationship. The analyses of structural 
patterns and behavioral components in the observations have indicated 
that several specific variables are directly related to the infant's 
language, cognitive, and socioemotional growth (Clark-Stewart, 1973) . 
These variables include affective warmth, face-to-face orientation,, 
and responsive (rather than directive) behaviors and verbalizations. 
It is these attributes which are the focal point of this study. Of 
special interest is the relationship between the mother's ability to 
interact in a manner which is responsive to the needs and capabilities 



6 

of her infant and the infant's ability to participate in a reciprocal 
manner. 

In summary, the research indicates that the infant is a competent 
human being--capable of responding to and with the environment. The 
infant posesses many competencies, yet is unable to perform certain 
tasks, and must depend on other individuals for life sustaining and 
enhancing functions. The quality of the care provided for the infant 
is the vital element which will promote the most positive growth during 
the child's first three years of life i^Gordon, 1975). lilkat KmcLLyvs -in 
qu^-i^on Jji qaaLttif ca^te p/iovJ.dzd by th.a. vzfiy uoang motIie.fi. 
HTiiie the risks of early parenthood 3.re obvious, the strengths of the 
young mother have yet zo be empirically documented. An assessment 
of the strengths and limitations of the mother-infant relationship 
and the infant's development will thus contribute toward a m.ore thorough 
understanding of their needs and: will make it '.possible to design mere 
comprehensive services for the j^oung family. 

Questions Addressed in the Study 

The independent variables under investigation in the study are 
age of the mother, education of the mother, sex of the infant, birth 
order, perinatal risk status, socio-economic status, social support 
system, ethnicity and participation in prenatal treatment and childbirth 
and parenting education programs. The relationships between and among 
the independent and dependent measures of infant development and mother- 
infant interaction were investigated by an overall test of no 
association between the two sets of variables. Follow-up tests on the 
specific variables under investigation indicated the degree- to which 
they contributed, to the prediction of developmental outcomes. 



7 



The general questions addressed in the study were investigated 
as follows: 

Ij Do infant development and mother-infant transaction vary as 
a function of the age of the mother? 

2) Is the relationship between the mother's age and each dimension 
of transaction and infant development linear after controlling 
for all other independent variables? 

3) What is the nature of the relationship between prenatal medical 
care and development at six months after controlling for all 
other independent variables? 

4) ftliich variables contribute predictive information to the 
identification of developmental delays on infant development 
measures at six months? 

5) Is there a positive relationship between the extent of prenatal 
and postpartum parenting education and infant development 

and m.other- infant transaction at six months? 

6) Is there a positive relationship between the extent of the 
m.other 's social support system and transaction and the infant's 
deveiopm.ent? 

Summary 

The purpose of this study was to investigate the transactional 
relationship between the adolescent mother and her infant and the 
infant's development. We have reason to believe that the young mother 
and her infant are at risk for problematic development; yet our current 
sources of information are limited in number and yield inconclusive 
findings. This study was designed to explore the unique contributions 



8 



of socioenvironmental , medical and educational variables in order to 
increase our understanding of the needs of the young raother and her 
infant. As a result, our interdisciplinary efforts to provide comprehen 
sive services will be able to become more sensitive to the special needs 
of the young family. 



CHAPTER II 
THE REVIEW OF THE RESEARCH 



This study was designed to explore the transactional relationship 
between the very young mother and her infant and her infant's development. 
In order to understand the implications of early parenthood on the 
mother and her baby, it is necessary to s>'nthesize the literature from 
several sources of knowledge. 

The variables which are the focal point of the present study -- 
prenatal and perinatal risk factors and socioenvironmental , medical 
and educational resources -- are presented in this review as they 
relate to the sequential development of the adolescent as a mother. 
Specific discussions of the role of the extended family and psycho- 
social influences on the young woman undergoing the transition to 
parenthood are presented within the context of each phase of the 
transition. These topics are also discussed as they relate to the 
development of the child bom to a very young mother. 

As noted previously, the adolescent undertaking the task of 
motherhood faces both a transition from her family of origin to 
psychological independence and the transition to the responsibilities 
of parenthood. Her relationship with her baby and her baby's growth 
can be viewed as a function of the mother's ability to establish 



9 



10 



equilibrium in these two multidimensional stages of develcprcent . The 
literature reviewed in this chapter has therefore been selected from 
two distinct fields: 1) the study of parent -infant transaction as 
it is related to infant development; and 2) the special study of 
adolescent parenting. 

A review of the research related to young mothers' transactions 
with their infants is limited by the fact that there exists but one 
observational study to date (Badger. et al., 1975). 'For this reason, n 
age-specific studies of the mother- infant relationship and transaction 
process as they relate to infant development are presented as a basis 
for understanding the process and the aspects which concern the young 
mother and her infant. The presentation of this material in such a 
manner is based on the assumption that therg are certain universal 
aspects of mothering and infant development and that these are 
generalizable to the study of adolescent mother-infant transaction. 
It is beyond the scope of this study to deal with the many issues 
associated with adolescent pregnancy, except as they concern the 
role of the mother and her baby's development. 

Parent-Child Transaction and Infant Development 

The emergence of current information regarding the newborn's 
competence and capabilities has been accompanied by investigations 
of the earliest years of a child's life and those who play signif- 
icant roles in the development of the child. The child's concept 
of self forms a major basis for the developmental process and has been 
thought to be related to early transactions between the newborn and 
parent, M'len the concept of self is viewed as a learned rather than 



11 

than an innate phenomenon",, the child's self-eoncept- -appears to develop- 

' as a furictior. o£ the growth, process through transactions with people 

of significance. Gordon (1966) summarized much about the development 

of the Self in infants and young children when he stated: 

Their original imiages of themselves are formed in the family 
circle. They develop the notions of who they are in relation 
to people around them, particularly through ways in which their 
behavior is received by adults who are important (and that) 
the origins of self-concept are the results of interactions 
with his parents and the meanings he assigns these experiences. 
(The Self thus becomes) the motivating and selecting factor of 
behavior (and learning) . . . and is the sum of subjective 
judgements he makes with regard to himself and his experiences, 
(p. 74) 

In this way, predispositioned feelings about self are conceived and 
ramifications for future development become evident. 

It becomes important then to turn to the more global studies of 
the parent-infant relationship. In this way we may better understand 
the development of the adolescent as a mother and the ramifications of 
this process for the growth of her child. 

How does the mother- infant relationship begin? iVhat is meant 
by the terms attachment and bonding and how do they affect future 
development? How can we better extend our understanding of these 
abstract concepts with more concrete evidence? These questions have 
prompted a considerable am.ount of research concerning the evolution 
of the newborn's first experiences within the family , (Ainsworth , 1972; 
Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). 
Let us review Brazeiton's (1973) discussion of the interrelated 
components through which the mother forms the beginning of attachment 
to the infant. The stages include: 1) planning the pregnancy; 2) con- 
firming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement 
of fetal movement; 5) acceptance of the fetus as an individual; 



12 



6} birth; 7) seeing the baby; 8) touching the baby; and 9) giving 
care to the baby. 

In view of the findings by Zelnick and Kantner (1978) regarding 
the large number of unplanned births to adolescent women, the subse- 
quent development of feelings of attachment to the infant remains 
in question. This is confounded by the fact that the pregnancy is 
often confirmed and acknowledged in the second or third trimester. 
These factors pose additional threats to the relationship between 
the adolescent mother and her infant. The delayed confirmation 
and acceptance of the pregnancy have remained unstudied with respect 
to their impact on the adolescent mother-infant relationship and 
are in need of further exploration. 

Wien considered within the framework of social learning and 
experiences, the feelings brought by the mother to the first encounter 
with her newborn are a product of her identification with her environ- 
ment, the effects of imitation and modeling, cultural influences, 
values and expectations (Klaus and Kennell, 1975). The role of the 
very young mother's environment and family of origin has thus been 
an important area studied with respect to early pregnancy and parenting. 
Fox (1978) notes the family's multifaceted impact on the adolescent as 
a social "interactor" which is operationalized through childrearing 
styles and by the quality of the relationships between dyads within 
the fa.mily and among family members. 

In studies of maternal -infant attachment, Ainsworth (1972) 
has examined the qualitative characteristics of interaction from the 
study of separation and has offered some defining attributes of 



attachment as a phenomenon. This attachment is viewed as an environ- 
mental adaptation evolving from the infant's attempt to gain proximity 
to the primary caretaker. Attachment differs from dependency in that 
it involves an affective preference for contact or multisensory 
stimulation, as opposed to the desire for the fulf illmenr of a physical 
need. Attachment is initiated through the process of mutual gazing and 
the establishment of eye contact with the mother. Observations have 
shovm that gazing is followed by locom.otor approach. Lamb (1974) 
stressed the need to view these characteristics as a series of inter- 
related components of behaviors which are uniquely individual expressions 
and must be viewed as a part of a seo^uence in the transactional process. 
Behaviors are then clustered to find measurable criteria without 
threatening attachment as a concept, 

In an attempt to categorize structural patterns and behavioral 
components and to quantify optimal maternal behavioral variables, 
several studies have focused attention on direct and videotaped observa- 
tions of dyadic interaction. Brazelton et al . (1975) stated that 
"it is through an early system of affective interaction that the develop- 
ment of an infant's identification v/ith cuirure, family and other 
individuals will be fueled" (p. 80). The study examined twelve pairs 
of mothers and infants involved in face-to-face interaction over a tv/elve 
month interval. Beha\dors such as vocalization, head position, 
direction of gaze, body position, amount of moveisent and handling 
revealed that the quality of each partner's actions were in direct 
relationship to the other. The behaviors were viewed as an indication 
of intentional affectivity and indicated that each partner modified 



14 



and adapted reciprocally in response to feedback from the other 
individual. The sequence of phases which emerged from the observa- 
tions of the mother- infant dyads comprised: 1) initiation; 
2) mutual orientation; 3) greeting; 4) play dialogue; and 5] dis- 
engagement. This notion of the infant's social self-regulation was 
interpreted from intentional explorations -- both cognitive and 
affective -- and the mother's ability to enhance the infant's attend- 
ing to her for important cues. 

Lamb (1977) supported the notion that the infant's active parti- 
cipation is directly related to a sensitivity to signals. He cautioned, 
however, that it is as yet unclear whether infants emit behaviors which 
elicit a response, or whether they regulate their own behaviors to 
engage in reciprocal interaction as a function of their intellectual 
competence. The question of the infant's competence in evoking a 
response has also been investigated by Sameroff (1979). He suggested 
that a distinct feature of the transaction (as opposed to interaction) 
model is the recognition given to the infant and the abilit^' of the 
infant to modify the environment. Ainsworth and Bell (1973) acknowledged 
the infant's contribution to the transaction process in the state- 
ment : 

Ifhatever the role may be played by the baby's 
characteristics in establishing the initial pattern 
of mother-infant interaction, it seems quite clear 
that the mother's contribution to the interaction and 
the baby's contribution are caught up in an interacting 
spiral. It is because of these spiral effects - some 
"vicious" and some "virtuous" - that the variables are so 
confounded that it is not possible to distinguish inde- 
pendent from dependent variable.*;, (p. 160)^ 

The relationship between infant competence ana the mother-infant 

transaction process remains in need of further exploration. 



15 

Tlie effects of the quality of mother-infant interaction on the 
development of both mother and infant has been investigated as well. 
An intensive nine month study of 369 eighteen month olds in repeated 
observations, interviews and developmental assessments, lends support 
to a view of social competence in the infant and "a dependence upon 
its nurturance through reciprocal transactions (Clarke-Stewart, 1973). 
Findings indicated a significant relationship between maternal stimulation 
responsiveness, and expression of affection and the child's developmental 
changes and social, emotional, cognitive, and language competence. 
The most influential factor was found to be the quality, rather than 
nonresponsive quantity, of verbal stimulation. Other important factors 
included the mother's role as an environmental mediator, her expression 
of positive emotion, and frequency of responsiveness, stimulation, or 
affectionate behavior as it related to the child's competence. The 
data suggested that responsiveness to the infant's behavior had a duel 
effect as it not only reinforcesl specific behavior, "but created an 
expectancy of control vfithin the infant which generalized to new 
situations and unfamiliar people" (Clarke-Stewart, 1973, p. 107). Other 
studies indicated maternal involvement with the neonate imm_ediately 
after birth as having positive effects on the mother's psychological 
state and thus her ability to reciprocate responsively (Powell, 1974; 
Klaus, KenneH and Krause, 1975). 

The. fact that many adolescents do marry or enlist the support o.f 
the :f ather necessitates .a.:.l!rief discussion of current -studies which have e 
plored the importance of the father's role and his transaction with 
the infant. By means of a self-report questionnaire and interviews, Wante 
Crockenberg (1976), examined the nature of the transition to fatherhood 
with respect to the husband- wife relationship and the effect of Lamaze 



16 



preparation for childbirth. V^ile it was noted that there existed a 
high correlation between the husband-wife relationship and total adjust- 
ment to perceived changes, medical preparation in childbirth was 
insignificant in facilitating adjustment after birth, mat appeared 
meaningful in the transition from dya.d to triad vas the sense of 
"family" established as a result of the father's participation in the 
birth. Total adjustment was found to correlate negatively with the disruption 
of affection and intimacy, a decreasing amount of time spent with the 
wife, and a discrepancy between the father's expected and actual care- 
taking role due to breast feeding. This aspect of early marriage and 
fatherhood has been virtually ignored with respect to early parenting 
CChilm-a.n, 1979) .. 

■ Studies of fathers' involvement have .supported'- the importance of 
the father- infant transactional relationship. Parke: and Sav/in's 
C1976} observations of fathers, both with the mother and alone with 
the neonate, indicated that the fathers were equally involved in 
establishing eye contact, holding, vocalizing and touching the infant. 
Fathers were also successful in caretaking routines, and often exceeded 
the mother's participation. In the context of feeding and on other 
measures, fathers were found to be sensitive to infant cues and were 
able to interpret infant behavior and modify their own behavior in 
response. It was also noted that farhers touched and vocalized to 
first-born males more often than to other offspring. Longitudinal 
studies indicated that those fathers who were given the opportunity to 
learn and practice skills in the hospital were more involved with 
infants at six months (Parke and Sawin, 1976). 

The results of the study on the strength of mother-child and father- 
child attachment supported the father's role in the child's developing 



17 



competence (Lamb', . 1976b) . During unstructured free-play in a laboratory 
playroom, observations of twelve month olds were used to measure 
the effects of each parent on the transaction process involving 
the other parent. The effect of a stranger's presence (a stressful 
situation) was also investigated in this study. The findings indicated 
a significant reciprocal effect in the presence of both parents on 
both mother-infant and father-infant relationships. The infant's 
affiliation behaviors -- smiling, reaching and touching — and 
interaction during play showed a preference for the father. In a 
stressful situation, however, primary attachment surfaced and infants 
under two years of age sought proximity to the mother. Lamb (1976) 
points out that the results of his two studies should not be used to 
equate affiliation with attachment as an affective preference for 
one parent or the other. 

The findings that early interpersonal transactions are of 
importance to the young child's development of competence stimulated 
further investigation into the expanding socialization process. 
This process has been shown to have a pronounced relationship to 
total development in infancy and throughout early childhood. The 
parent-child relationship was shovm to be related to the language, 
social, emotional and mental development measures of infants who 
were followed from nine to eighteen months of age (Clarke-Stewart, 
1973} . 

Based upon the assumption that the infant is preadapted to 
selectively attend to stimuli and facilitate adult-infant interaction, 
numerous studies have explored the notion that reciprocity is an 



18 



outgrowth of the mutual enhancement of feelings of efficacy (Ainsworth, 
1972; Bell, 1974; Brazelton et al . , 1975; Klaus and Kennell, 1975). 
The parent's distinctive interpretations of the infant's states of 
arousal have been shown to prompt an appropriate response to stimula- 
tion. The extent to which the behaviors of significant others can be 
anticipated from contextual events functions as a determinant of the 
quality and extent of the infant's responsive reaction (Goldberg, 
1977) . The ability of the young mother to interpret the state of her 
infant and facilitate appropriate transaction has been questioned by 
a number of authors (Hardy et al . , 1978; DeLissovoy, 1973) and 
was investigated in the present study. 

Beckwith et al . (1976) studied the preterm infants' inter- 
actions with their mothers at one, three and eight months of age 
through observations in the families' homes. Her findings indicated 
that infants whose Gesell developmental quotient was higher at nine 
months spent less time being in routine care at one and three months 
and were given more floor freedom at eight months. Higher scores 
on sensorimotor measures were associated with more m.utual gazing 
during one month observations, with smiling and contingent responses 
to distress at three months and general attentiveness at eight months. 
Beckwith 's (1971) study of maternal attributes and their infant's 
I.Q. scores revealed freedom to explore the home, experience with 
people other than the mother and the adoptive and natural mothers' 
socioeconomic status to be important interaction variables which were 
related to enhanced development. 

Much research has been undertaken which deals with dyadic communica 
tion skills in an attempt to trace qualitative interpersonal skills and n 



19 



essential characteristics of social reciprocity. From initial attachment 
bonds, the infant acquires skills in evoking a response and, as a result, '^ 
an "emotional connectedness" is formed between the infant and others 
(Bell, 1974; Brazelton at al., 1975). 

In looking at the quality of interaction of mothers and their young 
children, we can better understand the impact of the mother-infant rela- 
tionship in infancy. A recent study of early mother-child verval inter- 
action indicates the mother's capability to adapt her language behavior 
to cues from the young child. Moerk (1975) found a correlation between 
the mode, length and complexity of mothers' responsive lan.guage and the 
child's developmental level. This suggests that the young children's 
competence is related to their mothers' modeling, explanation, corrective 
feedback and expansion of their behaviors and ideas. Holtzman's (1974) 
findings further illustrate this concept of social learning in verbal 
content which stimulated the child to work through "contextual solutions 
from within his cognitive repertoire" (p. 34). The nonverbal aspect of 
interpersonal communication between five year olds and their mothers was 
explored by Schmidt and Hore (1970). They noted a difference between 
sopntaneous signals not intended as communication and expressive 
behavior transformed by the intention to communicate. Their findings show 
more use of reciprocal glancing and complex language with children of 
higher socioeconomic status. No significant differences in body contact 
or closeness were found to be associated with socioeconomic status. 

Emotional implications of the verbal and nonverbal environment 
were the subject of investigations done in sequential semi-structured 
observations of one and two year olds in middle class hom.es (Nelson, 
1973) . If was found that nondirective parental strategies which were 
accepting of the child's behavior, including feedback and nonselective 



20 

responding, were significa-nt in the facilitation of emotional and 
language development. Behavioral evidence which supports the effects 
of encouragement and reflective responsiveness was seen in laboratory 
observations of mother-child transaction as facilitating attention control, 
spatial orientation and field-independent cognitive styles (Bronson, 
1972; Campbell, 1975). In studies relating infancy to early childhood, 
the child of between three and five years was seen as able to interpret 
the level of expressiveness and abstractness and was developmentally 
verging on the ability to differentiate the "perspective reality orien- 
tation" of the partner through increasing empathy and decresing egocentri- 
city [Newman, 1976). Tnis suggested that from early transactions, 
the young child comes to learn how to affect another individual. Through 
this process, the infant (and young child) learns as well that the 
response of another is an expression of feelings and ideas and that 
these expressions are directly related to the process of interaction. 

Summary 

In summary, the development of the child appears to be strongly 
associated with the quality of the relationship between mother and 
infant. These studies which have dealt with the concept of transaction 
clearly demonstrate that the mother-infant relationship is of prime 
importance to the development of the child. Still, surprisingly little 
is known about the infants of adolescent mothers. Often our sources 
of information have been limited in generalizabi lity . They do, however, 
acKfiOwledge: the. -need- for concern regarding the psychosocial, educational and 
medical risks associated with early chi Idbearing. It is hoped that the 
consideration of the very young mother in future research will extend 
our knowledge base. Exploratory studies of the young parent family ivill thus 
strengthen efforts to improAAe the quality of professional services to 
the family as a unit and eniiance the quality of life for each individual. 



21 



The Young Mother and Her Infant 

Churchill once said crisis is a dangerous opportunity. 
If pregnancy in adolescence can be defined as the 
crisis, what [happens to] the infant may well be the 
dangerous opportunity , (Howard, 1976, p, 247j . 

This "dangerous opportunity" to which Howard referred is one about 
which very little is known. Hie past decade has given rise to great 
concern about the increasing numbers of adolescents who become 
parents each year. We have begun to investigate the medical, social, 
economic, psychological and educational consequences of early pregnancy 
and parenting, but surprisingly few studies have dealt with the 
development of the infants of very young mothers. Even less is 
knowTi about how the young mother relates to her baby--the strengths 
and weaknesses in her style of parenting. To date, too few observation- 
al studies exist which document her unique repertoire of mothering 
behaviors. Our present sources of knowledge are thus lacking in 
relevant information and are limited by a lack of methodological 
refinement in early research. 

Before proceeding to a discussion of the research related to 
early parent inr, it is necessary to explain some of the methodological 
problems in this area. In two separate reviews of rhe researcii, 
Crider (1976) and McKendry, et al., (1979) cautioned against the 
attempt to generalize from existing studies. In many cases, biases 
in our present sources are due to san^ie selections which were lack- 
ing in age specificity and inappropriate methodological procedures. 
Specifically, the analytical treatment of variables such as socio- 
economic status and mothers' age was such that we do not know hovi 
much each contributes separately to the outcome measures of early 
pregnancy and parenting. A persistent bias is found when statements 



22 



of generalization about the parenting style of adolescents are made 
without regard to the design of the given study. For example, many 
authors described negative behaviors of the adolescent parents 
(DeLissovoy, 1973; Presser, 1974}, but the sampling was such that only 
adolescents were included. If one is to suggest that young mothers 
display a higher incidence of dysparenting, it is necessary to include 
the "of age" mother in the design. Without this inclusion, we are 
unable to ascertain the relative contribution of mother's age to her 
style of parenting. A similar constraint is placed on generalization 
from studies of the infants of adolescent mothers. For this reason 
limitations will be noted in early research concerning the young mother 
and her infant. 

In order to better understand the consequences of early child- 
bearing on the mother and her infant it is necessary to compare the 
young mother to her "of age" peer. Variables of interest include the 
trends in birth rates, medical risks to the neonate and follow-up 
assessments of the infants of adolescents. Tliis review wil 1 therefore 
address these issues from the perspective of their relationship to 
the adolescent's role as a mother and the development of her baby. 
The Etiology of Early Pregnancy 

In looking realistically at newer research on adolescent parenting. 
It is evident rhat there are two distinct categories. One is the study 
of pregnant teenagers and the second is the study of teenage mothers. 
In other words, thejiz -os a ^txiLLng diU^^encz bPM.ozzn be.aorrUng a 
pn.zayiant tzzsr^gzJi md bdcoivUng a .te.e.n^gz motii^t. This issue is 
concerned with the element of choice upon the confirmation of pregTiancy. 
The individual ofT.en is able to choose whether to; 1) abort or 
continue the pregn,ancy; and 2) give the baby up for adoption or under- 
take the tasks of parenthood. 



23 



Several disciplines have taken issue with the phencraenal number 
of pregnancies which have occured during adolescence. The biomedical 
explanation of how and why pregnancy occurs is quite well known and 
involves the science of human reproduction. From the political, socio- 
logical and educational perspective we find that a large number of early 
pregnancies are also due to young people's lack of knowledge or misin- 
formation about contraception and a lack of confidential family planning 
services made available to them (Klein, 1978; McKendry et al., 1979). 

The psychological and psychosocial antecedents of early pregnancy 
are more intricate since we are concerned here with the dimensions of 
human sexuality. From this standpoint, early sexual activity and 
resultant pregnancy become more comprehensible. 

Paulker's (1970) data from a study of girls who became pregnant 
out of wedlock suggests that "the girls are not pregnant because they 
are different, but are somewhat different because they are pregnant" 
(p. 163). Rossi (1968) interpreted this concept in her discussion of 
the transition to parenthood and its direct relationship to the intent 
of the individuals involved. Rossi stated, "the inception of a pregnancy 
... is not always a voluntary decision, for it may be the unintended 
consequence of a sexual act that was recreative in intent rather than 
procreative" (p. 31). 

The question of intent has been explored by Zelnik and Kantner 
(1978) in their 1971 and 1976 studies of first pregnancies of women 
between the ages of 15 and 19 years of age. Tlieir findings, based on 
National Probability Survey statistics, revealed that there has been 
little change in the proportion of white teens who become sexually active 
and pregnant each year, but there has been a substantial decline in the 
number who delivered. The authors stated that "few who become 



24 

pregnant do so intentionally, but few who become pregnant use contracep- 
tion" (p. 11) . The black population evidenced little change in the 
number of first pregnancies and an eight percent decline in premarital 
intercourse. The authors stated that a discrepancy existed in the number 
of live births and abortions reported by Blacks which was possibly 
due to the negative attitude of the culture towards abortion. Blacks 
were noted to report a higher nvimber of live births and fewer abortions 
than were actually counted in the National Survey. It is important 
to note that any information obtained by means of self-report question- 
naires and interviews is that which the subject is willing to disclose. 
Ti-iis limitation is especially relevant to this study due to the extremely 
personal nature of the questions regarding intent. Regardless of 
the intent, we are faced with the fact that one million adolescents 
become pregnant each year (Alan Guttmacher Institute, 1976] . 

Turning to the study of adolescent psychology (or psychopatholog;^, 
as it may seem), several conflicting studies focus on the personality 
of the adolescent as an explanation of her sexual behavior. A composite 
personality profile of the pregnant adolescent is one of a young woman 
who typically came from a broken home, was sexually active with one 
partner on a steady basis, reached an early menarche, was sexually 
impulsive, narcissistic, sociopathic, rejected, isolated, lonely, 
unsuspecting, and/or unprepared (Kane and Luchenbrugh, 1973; Rosen, 
1661; Cobiiner at al . , 1973; Barglow et al . , 1967; Malmquist, 1967; 
Claman, 1969; Gottschalk, 1964). Another view is that "adolescent 
patients became pregnant being normal adolescents doing normal 
adolescent things" (Malmquist, 1967). Each of these studies is 
characterized by a methodological problem in either the use of small 
samples or the lack of a comparison group of women over the age of 



25 



19 years. A third approach to this area of studv is best summarized 

by Cutright (1971) in answer to the question, "who is the pregnant 

school -age girl and why is she pregnant?" Cutright answered: 

'Why is she pregnant?' To me this question implies a oath- 
ology behind pregnancy, and denies human sexuality. In the 
United States we keep trying to find out what kind of neople 
Cm psychological terms) get pregnant out-of-wedlock— what 
could we do if we found an answer? We do not ask of married 
women experiencing unwanted pregnancy 'why are you pregnant?' 
Yet 20 percent of white and 56 percent of all nonwhite legi- 
timate births during 1960-1965 were unwanted by the parents. 
Rather, we ask what means were available to control conception 
and gestation, and then move to devise a program to help 
married women control unwanted pregnancy and birth. We infer 
nothing pathological when we speak of unwanted pregnancy among 
married women, and it is time we do the same for unmarried 
pregnant women, (p. l'5^ 

The Growth and Development of the Very Young Mot her 

Now that we have briefly reviewed the background information 

regarding pregnancy in adolescence, let us turn to the resolution 

of the pregnancy; specifically, the decision to continue the pregnancy 

and become a parent. At the onset of this discussion, a clarification 

IS in order. In many instances, there is no viable choice to be made 

by the pregnant teenager. Unless pregnancy is confirmed during the 

first twelve weeks of gestation, abortion is no longer an option. 

Another constraint is the cultural pressure facing the adolescent 

which is quite ambivalent towards abortion. We have reason to believe 

this is changing (Hardy, 1978), but to date, there is a general lack 

of acceptance of abortion among members of minority cultures. This 

lack of acceptance of abortion as a viable alternative to parenthood 

should not be construed to mean that minority cultures condone or 

accept early pregnancy and parenting in their offspring. To the 

contrary, the works of Furstenberg (1976, 1978), Butts (197S) , Martinez 

(1978), and Wright^ Smith ^975) confirmed that feelings of disappointment. 



26 



social disgrace, and the stress or financial burden are feelings which 

are shared among all families of pregnant adolescents, regardless 

of their cultural origins. The family's reaction to the pregnancy 

has been shown to be important to the adolescent's development as a mother. 

As has been noted frequently throughout this work, we are concerned 
here with the special ways in which mothers and their infants 
establish a relationship and grow together. The study of early 
parenting involves a unique set of characteristics and stages through 
which the young woman must pass. 

The first stage following the confirmation of the pregnancy 
concerns the decision regarding its resolution. Because the adolescent 
often feels guilt, shame, and fear upon the acknowledgement (Furstenberg, 
1976) this becomes a critical point in her development as a mother. 
The study of this phase in the transition to parenthood has been 
synthesized by the three authors who, coming from the different 
perspectives of developmental and social psychology, have developed 
surprisingly congruent theories. The works of Chi Iman (1979) , Furstenberg 
(1978) " and Fox (1978) have emphasized the importance of the family (often 
referred to as "the family of origin") and especially that the mother- 
daughter relationship ha^s perhaps the most pronounced effect on how 
the pregnancy is resolved. 

Furstenberg (1976) has discussed the impact of the discovery 
of the daughter's pregnancy on the family. He found that for three - 
fourths of the families he studied, this was the family's first 
acknowledgement of the daughters sexuality. The reaction was often 
shock and disappointment. This contradicts the often held belief 
that early pregnancy and illigitimacy is an acceptable trend among 
lower socioeconomic and/or minority cultures. Presser (1974) 



27 

complemeDted this with her finding that there was an association between 

early maternal childbearing and the behavior of the daughter. 

Chilraan (1979) sited the fact that "daughters whose mothers had 

early pregnancies were more likely to become pregnant as teenagers", (p. 

As found in her earlier work, "actual maternal behavior is apt to be 

more influential than stated attitudes and goals for the [developmental 

outcomes of] children" (p. 209). 

The influence of the family of origin on the prevention of 
pregnancy and the use of contraception and abortion has been another 
area of interest. In general, the authors have concluded that a young 
girl's decisions both to become sexually active and to use contraception 
are related to her parent's values and support of her, her relationship 
with each parent and the degree of connectedness within the family 
CJessor and Jessor, 1975; Lewis, 1973). Fox (1978) cited the Rosen 
(1977) finding that, when adolescents consulted their families, the 
young woman was more likely to continue the pregnancy and keep her 
baby. In contrast, those who sought abortions rarely consulted their 
parents . 

The plans implemented by the young mother following the ; 
decision to continue the pregnancy were discussed by YoLing, Birkman 
and Rehr (1975). In their study of the role of the mothers of teens 
who carried their pregnancies to term, the mother was noted to be 
especially influential in the decision making process. TTie daughters 
living arrangements, educational plans and child care and childrearing 
arrangements were those most often influenced by the mother. 

We can look to the Mational Center for Flealth Statistics for a 
quantitative summary of those who gave birth during adolescence in 
order to understand the trends. In comparing the birth rate of 



28 



adolescents to that of older women, Baldwin (1976) has noted a 
peak in the rate for 18 and 19 year olds and older women. This 
peak occurred during the 1950 's and has declined steadily since that 
time. The decline has been less extreme for 16-17 year olds. For 
the youngest teens (< 15 years), the birth rate has risen. The 
comparison of birth rates by race has revealed a striking pattern. 
Baldwin noted "the birth and illigitimacy rates are both higher for 
black than white teenagers. However, recent rises in birth and 
illegitimacy rates in the young reflect changes in the white population. 
The birth rate for black teenager? has declined steadily and the 
illigitimacy rate is fairly stable (Baldwin, 1978)." 

A more recent survey from the final 1977 National Natality 
Statistics revealed a surprising trend in the fertility rate of those 
mothers below the age of 18. The fertility rate "declined slightly 
for women under 18 [as did the] rates of out-of-wedlock births among 
Blacks and whites younger than 15 and among Blacks aged 15-17" [Family 
Planning Perspectives . 1979] . While this most recent trend is 
encouraging, the fact remains that one of every five babies born 
today is bcm to an adolescent mother (Baldwin, 1978) . 

The rate of child bearing and its relationship to childrearing 
trends has been summarized by the Alan Guttmacher Institute (1976) . In 
1971, of those adolescents who gave birth out-of-wedlock, 87 percent 
kept their babies, five percent sent the baby to live with family 
members or friends, and' 8 percent gave the baby up for adoption. 
This large percentage of infants raised by very young parents has 
led to the study of the mother's ability zo care for her baby and the 
consequences of early parenting on the baby's development. 



29 



The Transactional Relationship Between the Very Yo ung Mother and 
Her Infant . — — 

The research to date regarding the adolescent mother- infant 
relationship is characterized by serious shortcomings. We are presented 
with problems in understanding the needs of the young family due to 
the fact that: 1) the transactional process has been virtually 
unstudied; 2) there is an extremely high degree of controversy in 
the research related to adolescent caregiving; and 3) when the rela- 
tionship has been explored, the sampling has been such that no 
comparison to the "of age" mother has been made. Our discussion of 
the adolescent mother-infant relationship is thus limited. It is 
to this specific gap in our knowledge that the present study was directed. 

As has been noted thrQughout', - the purpose- of 'this study was to 
address the questions regarding the behavioral repertoire of the 
young mother,— An important aspect of early parenting has been 
the developmental tasks of adolescence which bear heavily on the 
transition to motherhood. Fox (197S) summarized the importance of 
several tasks related to parenting which were: 1) resolving feelings 
about the family of origin in order to separate and become autonomous; 
2) an intense need for closeness and concurrent feelings of being 
"smothered"; 3) coming to terms with the "who am I?" question in 
defining one's self; and 4} the establishment of appropriate attach- 
ments apart from the family, .As has been stressed before, these are 
often ovenvhelming , and have been noted to influence the young m.other's 
relationship with her child. — • 

In a study of adolescent's expectations and attitudes towards 
their infants, OeLissovoy [1973} found disturbing charactristics of 
the young parents. He noted them to be "an intolerant group --impa- 
tient, insensitive, irritable and prone to use physical punishment 



30 



with their children" (p. 22). DeLissovoy also found young parents to 
have a lack of knowledge about child development and unrealistic 
expectations of the infant. It was suggested that this lack of 
knowledge governed the parents' actions to the child and constituted 
a form of emotional abuse. These findings were based upon interviews 
conducted during five visits in the homes of 48 adolescent families 
residing in semirural Pennsylvania. The results prompt a caution 
regarding their generalizability due to the lack of a comparison group 
of urban or adult parents (Crider, 1976). 

The conslusions reached regarding young mothers' inappropriate 
attitudes and expectations towards her child were discussed from the 
perspective of its relationship to her intent to becom.e pregnant. In 
an age-specific sample of 408 urban women (15-29 years) Pressor (197^1) 
found that almost half of all mothers between fifteen and nineteen vears 
of age wished they had postponed their first birth. The mothers cited 
the reason that the infant "restricted their life choices far more than 
they had anticipated" (p. 13). The author concluded that early first 
births and resultant child care are in need of more indepth investigation 
in order to assess their importance to the woman's development as a 
mother. Klein (1973) supported this notion of the adolescents' having 
been "less than adequate as nurturing mothers" (p. 1154), and concluded 
that the lack of knowledge and preparation for parenthood suggested a 
need for more appropriate interventions . 

Epstein (1979) addressed the lack of knowledge about infant develop- 
ment and its implications for mothering. On prenatal and six months 
postnatal assessments of 125 mothers in the High Scope Project, teens 
evidenced a lack of knowledge about the infants' cognitive and socio- 
emotional development. The author noted that "babies were seen as 



31 



passive creatures requiring little more than basic caregiving" (p. 64). 
The expectation of "too little too late" led to her conclusion that 
because young mothers are unrealistic about what they need to give, they 
"are likely to miss the gratifications able to be received from a baby" 
(p. 64). The results of this study provide valuable information regarding 
the educational needs of young mothers. Again, v«/e are unable to ascertain 
whether or not this lack of knowledge is attributed to youth due to the 
lack of a comparison group of older mothers. 

The findings regarding the problematic mothering style of the 
young mother have led to the often unwarranted conclusion that 
adolescents are likely to abuse and neglect their children to a 
significantly greater extent than the "of age" mother. Epstein C1S"9) 
contrasts her findings of expecting "too little, too late" with the child 
abuse literature regarding abuser's expectations of "too much, too soon." 
Crider (1976) noted the fact that most of the child abuse studies have 
found the infant's birthweight, not the age of the parent, to be signifi- 
cantly related to abuse. 

Kotelchuck's (1979) most recent investigation into the prediction 
of pediatric social illness has illum.inated the relative importance 
of the mother's age in predicting child abuse and dysparenting . His 
findings from a study in Boston revealed the parent's social isolation 
to be the most significant predictor of inappropriate or abusive T)arent- 
ing. In a discriminant analysis which accounted for 40 rsercent of the 
variance among abusers and nonabusers, the author found all measures 
of depression and isolation to be significant. No significant relation- 
ship was found due to mother's age, iimnediate stress, birth factors or 
baby temperment. 



32 



Extending this concept of the parent's social support system to 
the adolescent mother-infant relationship has proven to be illuiBinating. 
In a cross-cultural study of mothers and their newborns, Brazelton and 
Lester (Note 1) compared adolescent mother-infant dyads in Puerto Rico 
to those in the rural South. Their findings revealed the supportive 
nature of the extended family to be strongly related to both mother- 
infant transaction and the behavioral assessment of the neonate. 

Perhaps the most in-depth studies of the importance of the 
extended family to the adolescent mother-infant relationship are 
those of Furstenberg (1976; Furstenberg and Crawford, 1978). Kis 
longitidunal studies showed that most adolescent mothers were "apparent- 
ly loving, responsible, effective parents" (Chilman, 1979, p. 261} of 
young children, especially if the responsibilities of child care 
were shared by another adult. 

Furstenberg' s most recent work explored the family's support in 
the early years of parenthood and its relationship to longitudinal 
assessments of childrearing attitudes and practices. At the five 
year follow-up of a sample of 404 Baltimore families, no differences 
in mothers' reports of self confidence or raxings of parenx-child 
interaction were noted among families of differing residential careers 
or childcare arrangements. Among those mothers living alone or 
apart from the extended family, Furstenberg noted a higher level of 
control over the child's behavior ana a higher level of interest in 
the child. The author concluded that the mother's ability to establish 
her own support system independent of the family was an im.portant dimen- 
sion of her parenting role (1978) and evidenced a willingness to take 
responsibility for herself and her child. 



^6 



The impact of the extended family has yet to be explored within 
the content of varying mothers' ages. This is especially important 
m view of the large number of single-parent adolescent families. 
The most recent estimates reveal thar "39 percent of the children 
whose mothers gave birth before the age of 20 experienced a family 
breakup by age 15" ( Family Planning Perspectives . 1979, p. 115). 
Intervention Vv'ith Young Mothers and Their Infants 

In reviewing the outcomes of early parenting with respect to 
the mother-infant relationship, we are confronted with disturbing 
findings. Perhaps the most promising results, while few in number, 
have been the investigations of interventions designed to assist the 
young mother through her transition to parenthood. 

In a smaller (N = 39), quasi -experimental evaluation of the ef- 
fects of weekly mother-infant classes in a pediatric clinic. Badger 
(1974) found significant gains in mothers' knowledge of infant develo 
ment, nutritional needs and infant health care. Most promising were 
the significant increases in mothers' responsiveness to their infants 
and the infants' increased responsiveness to the mothers. Badger note 
that the program had a significantly stronger impact on the behaviors 
of the youngest mothers. 

In an educational and medical program for adolescents in Syracuse 
Osofsky and Osofsky (1975; 1978) examined the mother-child relation- 
ship among 450 dyads. The authors noted the young mother's warmth, 
physical interaction and attentiveness to their infants as being a 
strong foundation upon which interventions v^ere based. They also 
found a major weakness to be a lack of verbal interaction. 'Arhiie 



34 



the study lacked a comparison group of older mothers and adolescents 
who were given traditional treatment, the findings suggested important 
areas in need of intervention. 

Summary 

Our sources of information remain limited with respect to their 

methodology, scope and the documented strengths and limitations of early 

parenting. They do, however, provide an intriguing basis for both 

future intervention and research designs. In summary, the conflicting 

results of studies investigating early parenting are inconclusive. 

We are unable to ascertain whether young parents are any different 

in their caregiving attitudes, feelings and behaviors than parents 

who have postponed childrearing. Chilman (1979) systhesized the views 

of those who are more optimistic when she stated: 

^By age 16 or so, most young people are at a higher level 
of development and integration, but need more time to assess 
their values, goals and heterosexual relationships. Because 
child care requires the ability to be nurturant to another, 
to carry a heavy load of responsibility, to control one's 
impulses, to make ivise judgments, and to be able to provide 
the child with a wealth of experiences and firm guidance*, 
it seems unlikely that younger adolescents would'^on the 
average, be as effective in their childrearing as older ones. 
It also seems likely that, on the average, a premarital 
pregnancy would particularly strain a youthful marriage. 

On the other hand, 'ages and stages' are far from the 
whole story in human development and the capacity for parent- 
hood. People who have been 'well-parented' themselves", 
whose motivations, values, interests and experiences have 
particularly prepared them to care happily and effectively 
for children, may be excellent parents, regardless of t.heir 
ags,^ especially if various support systems are available 
to then in their own families and in the community, (p. 261) 



an sober truth, who can be and do all these things? (Chilzian, 1979, p. 26 



35 



The Children of Very Young Mothers : Perinatal Risk Factors 

Thus far, we have discussed early pregnancy and parenting from 
the perspective of the young mother. Of equal importance are the 
consequences of early childbearing and childrearing for the infants 
born to adolescents. Intuitively, we can guess that these infants 
are at high risk for medical, developmental and educational problems. 
Several factors have been brought to our attention by Crider (1976) 
and McKendry et al. (1979) in their reviews of the risks associated 
with adolescent pregnancy. The increased obstetric and neonatal risk 
of pregnancy in a physiologically immature woman has been repeatedly 
documented to have long range ramifications on the developmental 
outcomes of the infant (Grant and Heald, 1970). Tnis is often 
complicated by delayed and inadequate prenatal care, poor nutritional 
status, economic impoverishment, social isolation and emotional stress 
(McKendry et al., 1979). As with much research on early parenting, 
the investigations of the relationship between these factors and infant 
development have revealed inconsistent findings. They do, however, 
offer relevant information regarding the consequences of early pregnancy 
and parenting for the infants of young mothers. 

The most recent investigation of the prenatal, perinatal and neonatal 
complications associated with adolescent pregnancy was discussed by Ryan 
and Schneider (1978) at the University of Tennessee Center for the Health 
Sciences. The authors studied the obstetric -Derformance and the status 
of the neonate at birth among a predominantly black sample of 222 teens 
who were 19 years of age or less at delivery. The findings revealed 
these patients to have high rates of inadequate prenatal care, prenatal 
complications and complications during labor and delivery. The perinatal 
death rate was found to be twice that of the general population . 



36 

The neonatal complications indicated by low Apgar scores (< 5) , 
central nervous system depression, pallor and decreased tone were 
found to occur significantly more often in babies of adolescent mothers. 
These findings offer important information to be considered in the 
assessment of the developmental status of newborns of vei"/ young 
mothers. A methodological concern should be noted with regard to the 
author's comparison of their sample's results to a previously unspeci- 
fied sample of older teens and "of age" mothers. 

Tlie findings, as discussed above, about perinatal risk and mortalitv 
of very young (< 16 years) adolescents, have been consistently 
documented throughout the obstetric and pediatric research (McGanity 
et al,, 1969; Crider, 1976; Jones and Placek, 1978; Knox, 1971; and 
iMcKendry et al . , 1979). Additional obstetric complications of 
mothers under 16 years of age were found by Knox (1971) . Very young 
adolescents were noted to have a significantly higher incidence of 
cesearean section births, premature rupture of membranes and prolonged 
labor. Other obstetric complications summarized by McKendry et al. 
(1979) and Crider (1976) included abnormal presentations and infections 
at delivery (McGanity et al., 1969), uterine dysfunction and one day 
fever (Coates, 1970), and cephalopelvic disproportion (irreg-ular size. 
or position of the fetus head in relationship to the mother's pelvic 
structure) (McKendry et al., 1979). These problems have been related 
to the physiological and gynecological (the time span between the age 
at menarche and first pregnancy) immaturity of the -other (Zlatnik 
and Burmeister, 19~7; Erkan, Rimer and Stein, 1972). 

• The relationship between adolescents' obstetric complications and 
neonatal risk has been closely studied by several autiiors (Crider, 1976; 
McKendry et al., 1975; Mecklenburg, 1973; Dott and Fort, 1976: 



37 

Coates, 1970; Grant and Heald, 197Q; Hardy, 1971; Youngs et ai . 
1977; Semmens, 1965). Findings which were consistently dociiraented 
by these authors indicated that the infants of young mothers were 
at high risk for perinatal, neonatal, and infant mortality. Crider 
(1976) cited a North Carolina study of perinatal mortality in an age 
specific sample which found that the mortality rate tvas highest 
when mothers were under 15, and declined through the age of 20. : 
The rate of morbidity (impaired medical and/or developmental 
functioning) was also found to increase significantly as the mother's 
age decreased. Mother's age and medical risks to the neonate included 
respiratory distress syndrome, hyperbilyrubinemia, fetal distress 
with anemia, fetal distress with asphyxia (Coates, 1970), low birth- 
weight associated with prematurity and low birthweight associated with 
small size for gestational age (Crider, 1976) . 

In studies where a comparison group of "of age" mothers were 
included in the designs, we are presented with different findings. 
Niswander and Gordon's (1972) discussion of the National Collaborative 
Perinatal Study results indicated no significant differences between 
mothers under 20 years of age and those over 20 with respect to 
perinatal death. Neonatal death was found to occur significantly 
more often when the mother was less than 15 years old. Their data 
did not support an association between out of wedlock births and 
perinatal risk. Bott and Fort (1976) concurred with the finding that 
the "unique medical problems [of the adolescent] are controllable and 
do not differ appreciably from older women" (p. 536). 

McKendry et al . (1979) have summarized the limitations of 
studies which have regarded the age of mother as a single predictor 
of obstetric performance and neonatal status. The authors concluded: 



58 



These studies must be read carefully as a result of differ- 
ences in sample characteristics, the lack of controls, and 
the inconsistency of terminology. The reader should be 
especially wary of many review articles that treat these 
medical conditions as proven fact; ironically, many times 
these reports base their conclusions on inconclusive findings 
(Stewart, 1976). However, there appears to be more credence 
in the proposition that the young girl and her infant are high- 
risk . . . patients,, than in the proposition that they are 
not. (p. 23) _ 

When variables other than mother's age were analyzed as predictors of 
perinatal and neonatal status, the findings revealed no significant rela- 
tionship to the age of the mother. The variables that were consistantly 
noted to predict obstetric and neonatal outcomes were: 1) nutritional 
status of the mother; 2) socioeconomic status; 3} quantity of prenatal 
care; 4) parity (number of prior pregnancies); and 5) spacing of births 
(McKendry et al . . loyP; Menken, 1972; Dott and Fort, 1976; Stine, Rider 
and Sweeny, 1974; Mecklenburg, 1973). As noted earlier by Dott and Fort 
(1976), many of the nutritional, obstetric and family planning problems 
of adolescents are "controllable," but control remains dependent 
upon the professional community's ability to make these services 
available to young women and the woman's motivation to use them. 

Dv^yer's (1974) study of 231 12-16 year olds enrolled in a prenatal 
program found no significant incidences of anemia, toxemia, labor and 
delivery complications, low Apgar scores or post-partum problems. Pre- 
mature birth did result in 39 cases, however. Miile D\>7yer's findings 
are promising and suggest the managability of the adolescent's perinatal 
outcome, they are based on a study which failed to use a comparison 
group of older v/omen or those with different prenatal care. 

Semmen's (1961) study of 12,847 adolescents and nonadolescents 
who received care in a U.S. Naval Hospital found socioeconomic 
status, rather than race, raaxital status or age, to be the most 



39 



significant predictor of perinatal outcomes. The prematurity rate 
was identical in the two groups. The only difference was the 
adolescent's higher incidence of precipitate (less than three hours) 
labor and resultant fetal damage due to unattended deliveries. 

The Louisiana Infant Mortality Study (Dott and Fort, 1976) 
revealed that younger adolescents were less likely to utilize 
antenatal services and that, when adequate prenatal care was given, 
the perinatal and neonatal death rate was significantly lower. The 
authors discussed the role of social and demographic variables in the 
outcomes of the infants of young women. In the discussion of the 
roles of social and demographic variables in the outcomes of young 
women's infants, the authors concluded that "the burden of early 
motherhood falls most heavily on the offspring . . . infant morbidity 
and mortality are the greatest risks associated with [early child- 
bearing]" (p. 536). 

In a report of the Collaborative Perinatal Study at Johns Hopkins 
Medical Center, Hardy (Welcher et al., 1971) summarized the ramifica- 
tions of perinatal and neonatal outcomes in her statement: 

The scope of fetal wastage is two dimensional: 1) in terras '-f 
perinatal mortality; and 2) in terms of the perinatal insult, 
which while not sufficiently severe to cause fetal or neonatal 
death, results in long-term handicapping conditions of the 
surviving infant--for example, cerebral palsy, mental retarda- 
tion, congenital malformation, blindness, deafness and other 
neurological defects, (p. 238) 

This point was stressed as well by Dallas (1971). He extended 

Hardy's perinatal risk factors to conclude that "later fetal outcome 

and intellectual performance are dependent upon the complex interaction 

o± generic, biological and environmental variables" (d. 249). 



40 

The ramifications o£ neonatal risk on 'the development of the 
infants of adolescent mothers has remained relatively unstudied 
(Guttmacher Institute, 1976). There have been, however, a handful 
of longitudinal studies of children born to women enrolled in the 
Collaborative Perinatal Project (Niswander and Gordon, 1972). The follow- 
up assessments of these infants included the age of the mother in the 
design and constitute our main sources of information regarding 
developmental outcomes of the children of young mothers. 
Developmental Outcomes of Adolesce nt Pregnancy 

The earliest and longest follow-up assessments of infants of adoles- 
cents were done as part of the Johns Hopkins Child Development Study 
sponsored by the Collaborative Perinatal Project. For this investigation, 
Hardy, Welcher, Stanley and Dallas fl978) defined adolescence to be 16 years 
of age or less at delivery. The sample of 4,557 mother-infant dyads was 
selected at random in 1964 and followed at a rate of 85-93 percent over a 
12 year period. The sample consisted of 706 mothers who were 17 years of 
age or less at delivery. At birth, there were no significant differences 
between the under 16 and over 16 groups on perinatal or infant death rates. 
All risk factors were significantly higher for blacks than for whites. 

At eight months of age, infants were assessed with the Bay ley Scale s 
of Infant Development . The infants of mothers 20-25 years of age attained 
significantly higher scores on.. the__ mental scale than those of adolescents. 
Hardy concluded that this was suggestive cf "more effective childrearing 
practices" (p, 1224). At four years of age, children were assessed using 
the Stanford-Binet Intelligence Test for Children, tests of fine and gross 
motor functioning, the G raham Block Sort Con cept Formation Test, a behavioral 
profile and psychological i;T?pression. On all measuies, a higher proportion o 



children of adolescents were found to have inadequate outcomes. 
At seven years of age, the children of adolescent mothers performed 
less well than those of 20-24 year olds on the We schler Intelligence 
Scale for Children ( WISC) , the Bender-Gestalt Visual-Motor Test and 
the Wide Range Achievement Test ( WRAT) . The children of adolescent 
mothers were also found to have negative outcomes related to academic 
achievement and repetition of school grades on the twelve year 
assessment. Self-concept was measured by the Coopersmith and 
Piers-Harris tests. No significant differences were found between the 
children of adolescents and those of older mothers. 

Hardy et al . (1978) have provided an abundance of valuable 
information regarding the long term effects of early motherhood on 
the child. The negative developmental outcomes attributed to the age 
of the mother are distressing and suggest a need for early and intense 
intervention. A major limitation of this study is due to the 
lack of empirical evidence about the childrearing practices 
of the mothers involved. While other studies using Bayley measures 
at eight months have demonstrated that social, language and cognitive 
development were empirically demonstrated to be correlated with mother- 
infant transaction- (Beckwith, 1973; Beckwith et al . , 1976), the Hardy et 
(1978) study failed to assess the transaction process in a controlled 
situation. 

Furstenburg (1976) used interviews, tests and observational 
data in a longitudinal study of low-income Black adolescent mothers 
and their children. He found no differences on the Preschool Inventory 
in Che tliree year old children of 15 year olds when they were compared 
to those of mothers of 18 and 19 years of age. He did find significantly 
higher scores among children raised by more than one adult. Children 



whose parents married early and stayed married had the highest 
scores . 

In a five year follow-up, Furstenburg (1978- ) compared children 
of young mothers to children of older mothers who were in ureschools 
He found that children v/ho were cared for by grandparents in the 
home scored significantly higher than those who 'rfere in preschools. 
The author concluded that the child's cognitive ability was enhanced 
as a result of the aid his mother received from her parents which 
allowed her to become more educated and socioeconomically advanced. 
These findings point directly to the long term assets of the morher'j 
social support system. The study is limited, however, due to small 
size of the sample and the lack of a comparison group of nonBlack 
families . 

Holsti-um (1979) studied the intellectual, perceptual-motor, 
language and behavioral outcomes of premature infants at three years 
of age. Her findings revealed that socioenvironmental and neonatal 
variables contribute significantly to the prediction of develop- 
mental outcomes. Socioenvironmental variables investigated included 
mother's age, material resources and amount of social stress. Follow 
up sim.ultaneous univariate analyses revealed that the age of zhe moth 
did not contribute to the developmental outcom.e of three year olds. 

Broman, Nichols and Kennedy (1975) studied a sample of 26,760 
children born to m.others in the Collaborative Perinatal Project. 
They tested the significance of 169 prenatal and developmental 
variables in order to ascertain their ability to predict intellectual 
performance at four years. Their findings revealed that maternal 



43 



education and socioecnomic status were major contributors to explained 
variance in preschool IQ scores. The age of the mother was not found 
to be a significant predictor. Bayley assessments at eight months 
were found to be predictive of delayed intellectual development in 
early childhood. These findings are particularly interesting in that 
they reflect the contributions of the mother's age in a random, rather 
than age-specific sample. 

In an age-specific study comparing children of mothers under 
18 years (n = 86) to those at age 18 and older (n = 86}, Oppel and 
Royston (1971) investigated nurturing behavior, family composition, 
physical, social, and psychological characteristics. Subjects 
were matched on economic status, birthweight, parity and race. 
Data were collected at six to eight and ten to twelve years using the 
8inet and Wechsler intelligence tests, the Wide Range Achievement 
Test , psychological observations and the Maternal Behavi or Research 
Instrument . At both eight and ten years , children not reared by the 
biological mother were at significantly greater risk on all measures. 
There was also a significant difference in the child's physical size, 
which revealed more children of young mothers to fall below the 
third percentile in height. They also "displayed a trend towards 
lower weight" (p. 752). No significant differences in intelligence 
or psychological adjustment were found. Children of adolescents were 
at a significantly lower reading level, however, and were rated to be 
mere dependent and distractible . Younger mothers were noted to 
give m.ore independence to the child, were less anxious, had less 
intense emotional involvement with the child and were less likely 
to have intellectual interests. The conclusions reached by the 



44 

authors are based on thorough documentation. The use of a matched 
rather than random sample, however, has limited our understanding 
of the relative contributions of race, socioeconomic status and 
birthweights. Had these variables been controlled statistically 
rather than in the experimental design, the results vrauld have been 
more generalizable. Another limitation of this study is the fact that 
the data were collected for a purpose other than that for which they 
were analyzed. 

In summary, the long range outlook for the child born to a 
young mother appears quite dismal. Regardless of the methodology, almo 
every study has documented the intellectual, emotional, educational, 
developmental and medical risks associated with early pregnancy and 
parenting. Our only evidence of a more hopeful future for these 
children comes from those investigations into the role of the 
mother's support from her family and the professional comjnunity. 
Our knowledge base is lacking in both the number and scope of studies 
into the consequences of early parenting for the young mother and her 
child. It is to this specific gap in our knowledge that the present 
study was directed. 



CHAPTER III 
METHODOLOGY 

The purpose of this study was to ascertain the contribution o£ 
mother's age, perinatal risk status, and socioenvironmental , medical 
and educational resources to the prediction of mother-- infant transaction 
and the mental and psychomotor development of the infant. The population 
from which the sample was drawn consisted of mother-infant dyads who were 
served by the College of Medicine at the University of Florida. The sub- 
jects iv-ere stratified on the basis of the sge of the mother and were 
selected at random from the Birth Log at the Shands Teaching Hospital. 
Ninety-tiiro mothers and their six months old infants participated in the 
study. 

The assessment procedures consisted of a six minute videotape of 
mothers and infants in a free play situation and the administration of 
the B ayley Scales of I nfant Development . Demographic and socioenvironmen- 
tal data were obtained from the Child and Family Development Inter^v^iew 
which was developed for use in this study. Following the assessment, a 
parent and infant-centered protocol was implemented which was based on 
the infant's needs as assessed on the mental and psychomotor scales of 
the instrument. The data collection procedures were implemented in the 
Pediatric Clinic of Shands Teaching Hospital. The sample, design and the 
procedures for data collection and analysis are described in this chanter. 
As noted in Chapter I, the questions posed by th^e study were: 
1) Do infant development and mother-infant transaction vary 

45 



46 



as a function o£ the age of the mother? 

2) Is the relationship between mother's age and each dimension 
of transaction and infant development linear after control- 
ling for mother's education, yearly income, ethnic origin 
social support system, infant's sex and birth order and type 
of prenatal care? 

3) What is the nature of the relationship between prenatal 
medical care and development at six months after controlling 
for all independent variables? 

4) Which variables contribute predictive information to the 
identification of developmental delays on infant development 
measures at six months? 

5) Is there a positive association between the extent of 
prenatal and postpartum parenting education and infant develop- 
ment at six months? 

6) Is there a positive relationship between the extent of the 
mother's social support system and transaction and the 
infant's development? 

In keeping with the exploratory nature of this study, additional 
questions were investigated. The questions were: 

7) Is there a relationship between the age of the mother and infant 
development after controlling for transaction, infant's sex 

and birth order, perinatal risk status-, ethnicity, yearly 
income, social support system and t^'pe of prenatal care and 
education? 

8) Are the transactional behaviors of the mother- infant 



47 



relationship — warmth, reciprocity, responsive vocalization, 
negative affect and nonresponsive stimulation — associated 
with the mental and psychomotor development of the infant 
after controlling for mother's age and education, infant's 
sex and birth order, perinatal risk status, yearly income, 
ethnicity, social support system and type of prenatal care 
and education? 

9) Is there a relationship between perinatal risk status and the 
mental and psychomotor development of the infant after 
controlling for the mother's age and education, the infant's 
sex and birth order, yearly income, ethnicity, social support 
system and type of prenatal care and education? 
Definition of Terms 
For the purpose of this study, the following definitions of 
terms were used: 

1) Infant Development consisted of the composites specified by the 
Mental Development Index (MDI) and the Psychomotor Development 
Index (PDI) of the Bayley Scales of Infant Development . Tliese 
indices reflect the mental, psychomotor, language and socio- 
emotional competence of the infant . 

2) Mother- Infant Interaction is the categorical identification 
of behaviors described in the Beckw ith Behavior Scale . These 
behaviors were coded from videotaped transaction sequences. 

5) Reciprocal /Responsive Behavior is that which is observed to 

be directly related to the behavior of another individual. 
4) Nonresyonsive Behavior is that behavior vAich is observed 



48 



to be self-initiated and without regard to the behavior 
of another individual, 

5) Mother- Infant Transaction refers to the entire repertoire 
of interaction behaviors between mother and infant, 

6) Developmental Delay refers to a score of 68 or less on either 
the Mental or Psychomotor Development Index of the Bayley 
Scales Infant Development . 

7) High Risk for developmental delay refers to a score between 
68 and 84 on either the Mental or Psychomotor Development 
Index of the Bayley Scales of Infant Development . 

^i^^ foi" developmental delay refers to a score between 
85 and 100 on either the Mental or Psychomotor Development 
Index of the Bayley Scales of Infant Development . 
S) Prenatal Care by Private Physician refers to those patients 
who received obstetric treatment from physicians in the 
Private Diagnostic Clinic at Shands Teaching Hospital. 

10) Public Health Department Prenatal Care refers to those who 
received obstetric care at a public health department clinic. 

11) iVfaternal- Infant Care Clinic Treatment involved patients in a 
13 county area surrounding Gainesville, Florida. These 
patients received prenatal and postpartum obstetric, neonatal 
and pediatric care, family planning services, social service 
and nutritional counseling and optional prenatal childbirth 
education (Mahan, and Eitzman, Note 5). 

12) Teenage Pregnancy Team Care refers to patients who received 
prenatal and postpartum obstetric, neonatal and pediatric 



49 



care, family planning services, social service and nutritional 
counseling, a mandatory prenatal and childbirth education 
class and an optional infant, parenting and family development 
education class. This treatment was received by women who 
were 18 years of age and younger and who lived in a five 
county area within the Maternal -Infant Care district (Mahan, 
Note 2) . 

13) Shands Teaching Hospital (S.T.H.) High Risk Clinic refers 
to care which was specialized for those women identified 
as having a high risk pregnancy. Obstetric and neonatal 
services were provided and an optional prenatal and child- 
birth education class was offered to these women. 

The Subjects 

The population of interest in this study was that of mother- infant 
dyads residing in North Central Florida who were served by the College 
of Medicine at the University of Florida, Gainesville, Florida. Utiliz- 
ing the Birth Log (a list of information pertinent to labor and delivery 
records) available through the Shands Teaching Hospital, a stratified 
sample was draivn (;n=2S0) . Stratification was on the basis of mothers' 
ages (£15, 16-17, 18-19, 20-24, >_25 years). This method of sampling was 
used in order to obtain age specificity lacking in previous research. 

This method produced an age-specific sample of invited subjects 
who received the appointment letter, reminder postcard and phone call, 
as outlined in Appendix A. Socioeconomic and cultural representativity, 
while not expected, were additonai results of the sampling procedure 
and are presented in Table 7. 



50 

Of the 250 invited subjects, 92 participated in the study; complete 
data sets were obtained for 77 of these subjects. This attrition rate 
is comparable to that found by Resnick et al. (1978). The sample thus 
represents those subjects who were motivated to participate. Attrition 
was also due to other variables associated with poi'erty and/or early 
parenthood such as: 11 lack of trans^ro^ation; 2) conflicting school 
and work schedules; 3) moving out of the state; and 4) giving the 
baby up for adoption. Many families traveled as many as 150 miles to 
participate in the study. 

During the course of the data collection process, the investigator 
questioned a random number of subjects as to the reasons for participatin 
or not participating in the study. Responses included: "I thought I 
was supposed to come!" "I wanted to see how my baby was doing -- if he 
was doing o.k." ''We don't have a camera and I wanted a picture." "I 
was worried about my baby's arm, leg/ear." Negative responses included: 
"My baby's fine and I don't need you to tell me! I'm already potty- 
training him." 

Frequent attempts were made to call each family for whom a phone 
niuTiber was listed. In three telephone conversations, mothers refused 
to bring their babies to the clinic. These were private patients who 
were living in the Gainesville area. A total of 80 families were reached 
by phone prior to their appointments. Of the families who agreed to 
come, only 10 did not participate (2.5 percent). 

Procedure 

All subjects in the sanrole were contacted by mail to notify them 
that their babies vvere scheduled for a six month developmental assessment 



51 



in the Pediatric Clinic. When the families -- often including fathers, 
friends and extended family members -- arrived at the clinic, a brief 
explanation of the procedures preceeded the assessment. Subjects in 
the study were informed as to the nature of the developmental testing 
procedure employed and the purpose of the study. They signed a statement 
of informed consent, but were not told the variables under investigation 
in order to prevent bias during the data collection process (Appendix 
A) , Treatment of participants was in accordance with the standards of 
the American Psychological Association and the Committee for the 
Protection of Hioman Subjects at the University of Florida. 

Following an explanation of the procedures, the families were 
requested to come into the playroom where a mat and toys were available 
for play. Mothers were encouraged to engage in a brief play period 
prior to the actual videotaped sequence. The videotaped segment was 
then recorded as the mothers participated in free play with their 
infants. The initial play period (and the videotaped play sequence ■) 
was designed to allow the baby to adjust to the environment. Bach family 
was given the identical assortment of toys for the free play, which 
included rattles, balls, a mirror and a set of colorful faces. Mothers 
were told that the purpose of the free play was: 1) to allow the 
baby to adjust; and 2) to get an idea of how the baby played in an 
unstructured situation while at ease with the parent. 

Following the free play session, the examiner engaged in a two to 
three minute warm-up play period with the baby before administering the 
Bayley Scale s of Infant Development . Th.e parent was informed as to the 
nature of each task and its purpose in the assessment throughout the 



52 



administration of the scales. After the evaluation, the results regard 
ing the mental, psychomotor, language and socioeinotional growth of the 
baby were discussed with the parent with respect to age ranges in 
each area of development. Parent's questions were encouraged and 
concerns were discussed during all phases of the assessment. 

Following the assessment, the infant-centered intervention 
phase proceeded and focused on the specific strengths and limitations 
observed in the baby. Delayed or problematic development v;as ex- 
plained and appropriate protocols for remediation were discussed. 
It was emphasized that many of these delays found at six months could 
be overcome in a short time with an additional amount of stimulation 
and prescribed activities. Where applicable, developmental, 
nutritional and medical referrals were made to the appropriate agencies 
In all cases, parents were also given a book of educational activities 
and a photograph of their baby to take with them. 

Following the assessment, Infant and Family Development Specialist 
interviewed the mothers to obtain demographic data. This was done 
in order to insure that the examiner remained naive to the age and 
prenatal care group of the mother. 

Instrumentation 
The Assessment of Infant Development 

'^'^^ B ayley Scales of Infant Development were chosen as a direct 
measure of the infarcts' psychomotor and mental abilities. The 
mental scale measured adaptive and language behavior as evidenced 
on eye-hand coordination, problem solving, exploratory and manipula- 
tive tasks. Also included are linguistic vocalizations and the 



.53 



comprehension of coramunication by others. The :Tiotor scale measured 
gross body control and locomotion and fine motor coordination. 
Additional features of the instrument were its adaptability to the 
testing situation and the availability of a trained evaluator. 
Appropriate features of the test include the test materials, which 
were highly attractive to infants, and the administration of the 
test which allows the infant to be held by the mother. Split-half 
reliability coefficients for the motor and mental scales at six months 
are reported as .89 and .92, respectively (Bayley, 1969). 

In their study of test-retest reliability (v/ith eight m.onth olds} 
Werner and Bayley (1966) noted correlations between first and second 
assessments of mental and motor development to be .76 and ,75, respec- 
tively. These assessments were one week apart. Items involving emerging 
skills in social and interpersonal development and motor coordination 
were found to have a test-retest reliability of .76. This issue is 
especially important in a study of six month olds as this is a critical 
time for the emergence of several new behaviors. It is therefore 
necessary to acknowledge that a baby's score at six months could vary 
greatly from day to day. 

Inter-observer agreement is another aspect of reliability studied 
by Werner and Bayley (1966) . These coefficients were noted to be 
"markedly higher" than independent assessments since the same assessment 
was scored by each observer. Tester-observer reliability was found to 
be .89 and .93 on mental and motor development, respectively. 
Exam;ples of items in the scales can be found in Appendix C. 



54 



Perinatal Risk Status 

In order to assess the perinatal (last month of pregnancy through 
first month of life) risk status of the infant at birth, the Prenatal 
and Intrapartum Risk Scal e (Hoble et al., 1973) was adapted for use 
in this retrospective design. This instrument was developed as a 
system for the prospective analysis of perinatal risks and rates 
various complications in prenatal (maternal), labor and delivery and 
neonatal screening characteristics (see Appendix D) . Information 
regarding the risk status of the neonate was obtained from the 
infant's medical records. 
Mother- Infant Transaction 

The systematic observation of the transaction process has 
become a meaningful way to investigate behavioral components of 
the parent -infant relationship. 

In order to examine parenting behaviors, a low- inference obser- 
vation system was used. The measurement of maternal -infant interaction 
was based on the assumption that reciprocal/responsive behavior can 
be measured through the use of the Beckwith Behavior Scale . The 
scale was previously used by Beckwith (1976) and Grossman (1979) 
to analyze parent- infant transaction in two separate studies of 
one, three, six and eight month old infants and their mothers. 

Beckwith Behavior Scale consists of 27 behavioral categories, 
each of which is assigned individually to parent or infant behavior. 
The behavioral/ categories of the instrument were selected for 
their appropriate record of "parenting skills" which have consistently 



55 

demonstrated a strong relationship to infant development and were the 
focal point of this study: 

1) The constructive expression of affect (both positive and 
negative) . 

2} The ability of the parent to become in tune perceptually 
to the actual world of the infant at varied levels of 
cognitive and emotional development, 
3) The ability of the parent to interact with the child 
in a manner which is responsive to the actual state 
of the child as observed and interpreted over time. 
The behaviors and their descriptions are presented in Appendix B. 
Because of the highly sensitive and potentially ambiguous nature of 
the transaction process, it was necessary to pilot the use of the 
instrument within the experimental context under investigation 
and obtain appropriate estimates of intercoder reliability. A 
reliability study was previously implemented with Beckwith by computing 
a Pearson Product-Moment Correlation on independent ratings of 
two observers. On 18 behavioral categories, the coders were found 
to have a mean agreement of r = .92 (Beckwith, 1971; Beckwith et al . , 
1976). Similar observational records have been found to have predictive 
validity from observational records at nine months to Bayley mental 
scores at one year (Gordon, Soar and Jester, 1979; Long, 1979) . These 
studies assessed transaction among dyads of varied age, develop- 
mental and socioeconomic status. 

The decision was made to adapt the Beckwith Behavior Scale 
for use in this study based on several theoretical and practical 



■56 



aspects of mother-infant transaction. The instrument was originally 
constructed for observations of infants and mothers in the home. 
Certain variables (such as floor freedom and mutual gaze during 
feeding) were not applicable to this investigation. Another issue 
which influenced the adaptation was that the scale was constructed 
and implemented with preterm infants and their caregivers at one, 
three and eight months of age and adapted by Grossman (1979) for 
use with infants of six months of age. These considerations were 
of importance in this study and were the basis upon which some 
original variables were substituted with ones which were more applicable 
to the simulated playroom setting in a study of six month olds. 

The coding of the videotapes was also adapted so that be- 
haviors were coded every five seconds or when the behavior changed . 
rather than every 15 seconds as originally implemented. The rationale 
for this adaptation was based on the dynamic characteristics of 
mother-infant transaction which necessitated the more precise 
analysis of the process as behaviors occur in a five (rather than 15) 
second time span. 
Interobserver agreement 

The issue of reliability--the extent to which measures of be- 
havior are measured con3istently--has been a subject of great concern. 
This concept is best clarified by Cronbach and Rajartnam (1963) in thei 
statement: "an investigator asks about the precision or reliability 
of a measure because he wishes to generalize from the observation 
in hand to some class of observations to which it belongs " (p. 144). 



The two observers were selected on the basis of their prior 
experience in coding parent-infant transaction videotapes. In 
another study (Eyler, 1979) these observers evidenced skills in 
analyzing observable behaviors of mothers and their premature new- 
boms and were found to be consistent in their ratings. 

Training of the coders involved detailed explanations and 
numerous examples of each behavioral category. The observers were 
assessed initially and at randoro.ly determined periods throughout 
the coding process in order to ascertain the extent to which 
behaviors were rated consistently. Fifteen of the videotapes were 
coded by both coders. This permitted the assessment of intercoder 
reliability. Table 1 presents the Pearson Product-Moment Correlations 
between the frequencies reported by the two coders. 

In order to reduce the number of variables to be used in 
subsequent analyses and to represent more global dimensions of 
mother-infant transaction, a correlation matrix of observation ■ 
measures was subjected to a Principle-Component analysis using the 
variraax rotation. The results of these analyses are discussed in 
detail in Chapter IV. 

Statistical Analyses 
The variables under investigation in the study were the age 
of the mother, the education of the mother, the sex and birth order 
of the infant, perinatal risk status, yearly income, ethnic origin 
and t]/-pe of prenatal care. The analyses were designed to assess 
the contributions of these variables to the prediction of 



58 



Table 1 

Inter-Observer Reliability of 
Mother- Infant Transaction Behaviors 



Behavior 



ienavior 



Mother Behaviors 

Coranents .88 

Commands .70 

Criticizes . 95 

Nonverbal Bid ,67 

Initiating Behaviors .73 

Repetitive Nonverbal Bids . 89 

Staccoto Bursts 1,00 

Affectionate Touches .83 

Interfering Touches .19 

Repetitive Verbalizations 1.00 

Baby Behavior 

Bid to Caregiver .90 

Smiles ** 

Vacant Behavior ** 



Baby Explores .69 

Baby Fusses 1.00 

Reciprocal Behavior 

Mother's Positive Response .82 

Mother's Negative Response ** 

Mother's Contingent Ver- .97 
bal/vocalizations 

Face to Face Orientation .88 

Mother's Ignoring Response .95 

Baby's Positive Response .68 

Baby's Negative Response ** 

Baby's Contingent Vocal- ** 
ization 

Mutual Gaze ** 

Baby's Ignoring Response .31 



'^No correlation computed: one or both ratings evidenced no variability. 



59 



Table 2 

Means and Standard Deviations 
for Beckwith Behavior Variables 



Variable 




Mean 




SD 


Comments 


7 


.6154 


5 


.7349 


Commands 




.7564 


1 


.5474 


Criticizes 




.6923 


I 


.6221 


Nonverbal Bids 


3 


.7051 


3 


.6328 


Initiating Behaviors 


13 


.0897 


5 


.2476 


Repetitive Nonverbal Bids 




.0251 




.8430 


Staccato Bursts 




.6667 


1 


.904 


Affectionate Touch 


1 


.7692 




.8916 


Interfering Touch 


1 


.9744 


2 


.2961 


Repetitive Verbalizations 




.2308 




,8046 


Bid to Caregiver 




. 6667 


1 


.1584 


Baby's Vocalizations 


1. 


,6538 


2, 


,4697 


Baby's Smiles 




,9487 


1 , 


,9863 


Self -Stimulation 




,0128 




,1132 


Vacant Behavior 




0128 






Baby Explores 


16. 


7051 


9. 


3602 


Baby Fusses 


1. 


0769 


'7 


1200 


Mother's Positive Response 


4. 


1026 


2 . 


9081 


Mother's Negative Response 




1026 




3810 


Mother's Contingen;: Vocalizations 


1. 


1026 


1 . 


9177 


Face-to-Face Orientation 


3 . 


5513 


3 . 


6597 



60 



Table 2 Cont. 



Variable 



Mean SD 



Mother's Ignoring Response .7564 2.8.108 

Baby's Positive Response 12.6538 6.0663 

Baby's Negative Response .3333 .8778 

Baby's Contingent Vocalization .2179 1.3737 

Mutual Gaze .0641 .2945 

Baby's Ignoring Response 3.7051 3.6149 



61 



mother- infant transaction and infant development as outcome measures 
of early pregnancy and parenting. 

In order to reduce the number of variables and represent 
the more global dimensions of mother- infant transaction in subsequent 
analyses, a correlation matrix of the 27 behavioral categories was 
subjected to a Principle Components analysis. As a result of this 
analysis, five dimensions of mother- infant transaction were defined 
and each subject's incomplete composite component score was calculated 
for each of the five components. These calculations were based on 
the addition of the total number of behaviors which had a positive 
loading on the component and the subtraction of the number of 
behaviors which had negative loadings on the component. The 
reliability of the observers was computed on each of the five com- 
ponent score dimensions using a Pearson Product -Moment Correlation 
procedure. These analyses were executed using the Statistical 
Package for the Social Sciences [SPSS) (Nie et al., 1975). 

In the first multivariate multiple regression analysis, the 
dimensions of mother-infant transaction and the infant's mental and 
psychomotor development were considered to be the outcome measures 
of early pregnancy and parenting. These measures were therefore 
treatea as dependent variables and were regressed on mother's age 
and education, baby's sex and birth order, yearly income, ethnic 
origin, social support -system, perinatal risk status and type of 
prenatal care . 

The second multivariate multiple regression analysis addressed 
the question regarding the ability of the transaction components to 



predict the mental and psychomotor deAAelopment of the infant. 
In this analysis, mental and psychomotor development were regressed 
on mother's age a.nd education, baby's sex and birth order, ethnic 
origin, yearly income, social support system, perinatal risk status, 
type of prenatal care and the five dimensions of mother-infant 
transaction. The multivariate multiple regression analyses were 
executed using the General Linear Model program of the Statistical 
Analysis System (SAS) (Barr et al., 1976). 

Lim.itations of the S tudy 
The use of videotape analyses in a low- inference observation 
record to measure interaction between individuals is subject to the 
limitation imposed by the fact that the behavior observed is that 
which the adult subject is willing to express in the given situation. 
This effect is confounded as well by the atmosphere found within 
any medical setting; this often produces anxiety in the mother 
and thus affects infant behavior. In an attempt to alleviate 
possible stress in the assessment environment the "playroom" setting 
was simulated in the Pediatric Clinic. 

The purpose of an evaluation of infant development at six months 
of age is to establish a baseline for use in diagnostic and pre- 
scriptive protocols regarding the infant's strengths and limitations. 
While the information obtained is useful for the identification of 
competencies and delays, the scales are unable to predict future 
development . 

-Another limitation is the fact that the families studied were 
those who responded to the request and were motivated to participate 



63 



in the study. Those subjects who were contacted, but did not par- 
ticipate may differ systematically from those who participated. 

A final limitation placed on the study is the ex-post- facto 
or correlational nature of the design. While associations and 
relationships among the variables can provide useful information, 
no inferences of causality can be interpreted from the results 
of the study. 

Summary 

In siimmary, the data were collected and analyzed in order ro 
assess the behavioral dimensions of mother-infant transaction and 
the mental and psychomotor development of the infant in an age 
specific sample. In addition, the study was designed lo explore 
the mother's age, social support system, perinatal risk status, 
prenatal medical care, and participation in childbirth and parenting 
education programs in order to assess their contributions to the 
prediction of transaction and development at six months. The 
results of the analyses are presented and discussed in Chapter IV. 



CHAPTER IV 
RESULTS 



The purpose of this study was exploratory in nature and was 
based on the fact that relatively little is known about the develop- 
mental outcomes of very young mothers and their infants. The analyses 
were implemented in order to ascertain the contributions of the 
mother's age, social support system, perinatal risk status, type of 
prenatal care, type of prenatal childbirth education and t>'pe of 
parenting education as they related to mothers' transactions with 
their infants and the infants' development. The questions addressed 
in this study and the analyses are discussed in this chapter. 

The Dimensions of Mother- Infant Transaction 

Before proceeding to the analyses which addressed the major 
questions posed by the study, the dimensions of mother-infant 
transaction were studied. The nimhev of behaviors in each category 
of the .'Adapted Beckwith Scale were first tallied for each subject. 
A correlation matrix of the variables was then subjected to a Principla 
Components analysis. 

The analysis yielded eleven components with eigenvalues 
greater than 1.0. These components accounted for 74 percent of the 
variance. The components corresponding to the five largest eigenvalues 
were rotated using the Varimax procedure. The five rotated components 



64 



6S 



accounted for 46 percent of the variance. Table 3 reports the 
loadings o£ the variables on each component. Table 4 reports the 
factor score coefficients of the variables. 

The results of the Principle Components analysis were used 
to guide the formation of the subjects' composite scores on each 
of the five components. Variables were included in these scores 
such that those with factor score coefficients greater than .25 
defined the component. In the fifth component, mother ' s negative 
responses were included in the composite component score based 
upon theoretical interpretations of the observed behaviors of the 
mother-infant transaction process. The total number of tallies per 
behaviors with positive coefficients were added to calculate each 
component score. The behaviors which had negative coefficients were 
subtracted from this sum. This process often resulted in the com- 
posite score of a subject on a component being less than or equal to 
zero. The following formulae were used to calculate the composite 
scores on each of the five components: 

Component Score 1 (Warmth) = Affectionate Touches + 

Smiles + Face-to-face Orientation 
Component Score 2 (Reciprocity) = Baby's Positive Responses + 
Mother's Positive Responses + Initiating Bids - 
Baby's Exploratory Behavior 
Component Score 3 (Responsive Vocalization) - Baby's Vocali- 
zations + Mother's Contingent Vocalizations + 
Baby's Contingent Vocalizations - Mother's 
Nonverbal Bids 



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E— 







70 



Component 



Score 4 (Negative Affect] = Mother's Commands + 



Mother's Criticisms + Mother's Interfering 



Touches + Baby' 



s Negative Responses 



Component 



Score 5 (Nonresponsive Stimulation) = Mother's 



Staccato Bursts + Mother's Interfering Touches + 



Baby's Ignoring Responses + Mutual Gaze + 



Mother's Negative Responses 



A Pearson Product -Moment Correlation procedure between the 
frequencies of the original variables and the component scores 
was implemented. The correlation coefficients are reported in 
Table 5 and indicated that the individual variables chosen to 
compute the component scores are highly correlated with the new 
composites. It also indicated that the variables which should not 
be correlated with the components were not. These coefficients 
supported the interpretation of the composites of variables selected 
to define the dimensions of mother- infant transaction. 



The reader should recall that 15 of the videotapes were coded 
by two coders. This permitted the computation of two composite 
scores for each component of mother-infant transaction and the 
assessment of interobserver reliability for the composites. The 
Pearson Product -Moment Correlations between each pair of composite 
scores are reported in Table 6, The results of this analysis 
indicated that the two observers were consistent in the coding of 
the five dimensions of the transaction process. 



71 







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73 



Table 6 

Interob server Reliability of 
Mother- Infant Transaction Components 



Component 



Warmth , 9 i 

Reciprocity ,97 

Responsive Vocalization ,75 

Negative Affect , 80 

Nonresponsive Stimulation .70 



74 



Description of the Saiiiple 
Descriptive statistics and a correlation matrix of the 
independent and dependent variables were calculated for the sample 
of 77 mother-infant dyads. Frequency distributions were calculated 
for the independent and dependent variables and are reported in 
Tables 7, 8 and 9. The means and standard deviations of the 
dependent variables are presented in Table 10. 

An inspection of of the distributions of the measures 
of perinatal risk indicated that the majority of the sample "was 
within normal limits at birth. The means and frequency distributions 
for the measures of infant's mental and psychomotor development 
indicated that the entire sample was within normal limits of 
development at six months of age. The means of the sample are 
considerably higher than those reported in the Bayley Scales of 
Infant Development Manual (Bayley, 1969). The standard deviations 
of the sample are equivalent to those reported in the manual. An 
interpretation of these findings is discussed in Chapter V. 

Interobserver reliability was then computed by means of a 
Pearson-Product Moment Correlation on the rotated component scores. 
The results of this analysis are presented in Table 6. The purpose 
of the assessment of interobserver reliability was to measure 
the extent to which the two independent observations of behavior 
were consistent. From "che results of this analysis it can be 
seen that the measurement of transaction was consistent across 
observers . 



75 

Table 7 

Frequency Distributions for Several Independent Variables 



Variable Frequency 


Variable 


Frequency 






Baby's Sex 




< 15 


c 


Male 


40 


16-17 


J. 


Female 


37 


18-19 


1 ^ 


Baby's Birth Order 




20-24 


1 o 


1st Born 


54 


> 25 


7^ 


2nd Born 


17 


Race 




3rd Born 


S 


Black 


4? 


7th Bom 


I 


NonBI ack 




Yearly Income 




Prenatal Care 




< $3,000 


19 




^ u 


$3,000 - s^5,000 


18: 


Ma tern a I In ■Fan t T.'^tp Pto i 


1 Q 

.1. .7 


S6,000 - $10,000 


21 


Shands Teaching Hospital 


13 


$11,000 - $20,000 


15 


Public Health Department 


9 


> $20,000 


4 


Pt*-! a (=i 

L ± _L y CI. C 


1 A 
J- O 


Social Support System 




iVfo "t" ^ (^T* ' c P .'"i 1 1 r* Q "t" "1 r\T> 




0 Living alone-no asst. 


\ 


< 12 years 


37 


1 Cohab. Support Only 


53 


12-14 years 
15-18 years 

Prenatal Complications 


31 
9 


2 Cohab. q Income or 
Chi 1 dear e Asst. 

3 Cohab. § Income % 
Childcarfc Asst. 


38 
5 


Uncomplicated Pregnancy 


59 


r c^. .LncLLa,i AXblS. uCaLub 




Presence of Complication in 
Pregnancy (.i\nemia, Toxemia, 
Veneral Disease or Infec- 
tion) 


18 

1 


< 10 Points 
10 - 19 Points 
20 - 40 Points 
> 40 Points 


37 
•20 
18 
2 



I 



76 



Table 8 

Frequency Distributions for 
Mother- Infant Transaction 



Variable Frequency 
Warmth 

0- 15 69 
16-30 7 
51-50 1 

Reciprocity 

-25 - 0 16 

1- 25 38 
26 - 52 23 

Responsive Vocalizations 

-20 - -10 4 

-9-0 47 

1-9 23 

10-33 3 
Negative Affect 

0-4 52 

5-9 19 

10-23 6 
Nonresponsive Stimul a t i on 

0-4 32 

5-9 31 

10 - 19 12 

20 - 57 7 



77 



Table § 

Frequency Distributions for 
Infant Development Variables 



Variable Frequency 

Bayley Scales of Infant Development 

Mental Development Index 

< 68 0 
68-83 1 
84-99 7 



100 - 116 
117 - 132 
133+ 

Physical Development Index 
< 68 
69 - 83 



18 
22 

29 

0 
0 



84-99 8 
100 - 116 ! 
117 - 132 
133+ 



24 
35 
10 



78 



Table 10 

Means and Standard Deviations for Scores 
on the Bayley Scales of Infant 
Development, and the Beckwith Behavior Scale 



Variable 



N 



Mean 



SD 



Bayley Scales of Infant Development 












Bayley Mental Index 


77 


125 


28 


19 


26 


Bayley Psychomotor Index 


77 


117 


64 


12 


62 


Component: Beckwith Behavior Scale 












Warmth 


77 


6. 


29 


6 


95 


Reciprocity 


77 


12. 


96: 


18 


16 


Responsive Vocalization 


77 




67 


6 


58 


Negative Affect 


77 


3. 


71 


4. 


39 


Nonresponsive Stimulation 


77 


5. 


55 


5. 


84 



79 



An initial inspection of the cross tabulations revealed 
the type of prenatal care to be highly correlated with the type 
of prenatal childbirth and postpartum parenting education received 
by the mother. The type of prenatal care received by the mother 
determined to a great extent the type of educational program she 
was offered. As a result, prenatal childbirth education and 
parenting education vrere omitted from further analyses. The 
variable "type of prenatal care" contained more information due 
to the differences in prenatal and parenting education programs 
offered in conjunction with prenatal medical care. The cross 
tabulations are presented in Table 11. 

The correlation matrix is presented in Table 12 and 
indicated that the perinatal risk status of the mother and infant 
were not correlated with the presence or absence of prenatal 
complications. Complications found among women in this sample 
included anemia, toxemia, venereal disease and infection. The 
fact that these risk factors were uncorrelated was not expected 
due to the fact that the measure of perinatal risk included 
prenaxai complications. It is possible, however, rhat the 
rating system employed by the scale is not useful for studies 
which are retrospective in nature. Another possible interpreta- 
tion is that the scale may not be sensitive to the importance 



80 



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83 



of the many prenatal complications present in adolescent patients. 

As a result, the presence or absence of prenatal complications 

was incliided in subsequent analyses. 

The Relationship of Mother's Age, Perinatal Risk Status an d 
Socioenvironmental, Medical and Educational Resources 
To Mother- Infant Transaction and Infant Development 

In keeping with the exploratory purpose of the study which 

was to obtain information regarding the outcomes of early pregnancy 

and parenting, a number of hypotheses were tested. Two multivariate 

analyses were implemented which involved several multiple regression 

procedures. These analyses, which addressed the ability of the 

independent variables to predict mother-infant transaction and 

infant development, were subjected to a conservative critical value 

in each univariate and multivariate test of significance. The 

experimentwise alpha rate was set at .05 for the multivariate tests. 

Using the Bonferroni approach, this v/as divided by the total number 

of dependent variables such that the criterion for significance was 

dependent upon the hypothesis being tested. On each univariate 

follow-up analysis, the criterion for significance was set at .01. 

Mother's Age as a Predictor of Transaction and Development 

The questions of utmost importance in this study concerned: 

1) the ability of the very young mother to facilitate positive 

transaction with her baby; and 2} the developmental status of the 

infants of young mothers. This led to the questions regarding 

the nature of the relationship between mother's age and transaction 

and development. The specific questions addressed in the first 



84 



analysis were: 

Question One: Do infant development and mother- infant interaction 
vary as a function of the age of the mother? 

Question Two: Is the relationship between mother's age and each 
dimension of transaction and infant development 
linear after controlling for all independent 
variables? 

To test the hypothesis that there would be no relationship between 
mother's age and interaction and development, a multivariate multiple 
regression analysis was used. In this analysis, the dependent measures 
were mental development, psychomotor development, warmth, reciprocity, 
responsive vocalization, negative affect and nonresponsive stimulation. 
The independent variables were mother's age and education, baby's sex 
and birth order, ethnic origin, yearly income, social support system, 
prenatal complications, perinatal risk status and type of prenatal care. 

The results of the univariate tests of the contribution of each 
dependent variable to overall prediction indicated that only mental 
development was significant. The results are presented in Table 13. A 
visual inspection of the plot of the residuals against the predicted 
values of mental development revealed that the data met the assumption 
of homoskedasticity (homogeneous error variance around the regression 
line) and were appropriate for the analyses. 

Tne tests of significance of the multivariate main effects (Table 
1.4) indicated that the age of the mother did not contribute to the overall 
prediction of mother-infant transaction and infant development (a-. 05), 
but did contribute to the prediction of the infant's mental development 



85 



Table 13' 

Results of the Univariate Tests of the Contributions 
of Several Dependent Variables to Mother- 
Infant Transaction and Infant Development 



Dependent Variable 


R 


P 


Mental Development 


.34 


<.01 


Psychomotor Development 


.27 


.06 


Warmth 


.23 


.15 


Reciprocity 


.19 


.32 


Responsive Vocalization 


.14 


.05 


Negative Affect 


.17 


.49 


Nonresponsive Stimulation 


.18 


.44 



86 



Table 14 

Results of the Multivariate Significance 
Tests of Contributions to Mother- Infant 
Transaction and Infant Developinent 



V u-X X d. L/ J. c 


F* 


d£ 


P 


Mother's Age 


1.45 


7,57 


- .20 


Baby's Birth Order 


1.07 


7,57 


.. .40 


Baby's Sex 


2.05 


7,57 


. .06 


Ethnic Origin 


1.35 


7.57 


. ,.:25 


Social Support System 


. 84 


7.57 


- .36 


Mother's Education 


.93 


7.57 


. .49 


Yearly Income 


1.81 


7,57 


. : . 10 


Type of Prenatal Care 


1.60 


28,206 


. .03 


Prenatal Complications 


1.37 


7,57 


. ■ .:23 


Perinatal Risk 


1.11 


7,57 


. ■.37 



*Transformation of Wilks' Criterion to an F statistic 



S7 



(a^.Ol). The results of this analysis did not support the hypothesis 
that the psychomotor development o£ the infant and the mother- infant 
transaction process varied as a function of the age of the mother. The 
results of the univariate analyses are presented in Tables 15 and 16. 

The preceding multivariate multiple regression analysis was 
also designed to answer additional questions posed in the study: 

Question Five: Is there a positive relationship between the 

extent of prenatal care, prenatal and postpartum 
parenting education and infant development and 
mother- infant transaction at six months? 
Question Six: Is there a positive association between the 

mother's social support system and transaction and 
the infant's development? 
The analysis of the multivariate main effects (Table 14) revealed 
that the presence of prenatal complications and the t^-pe of prenatal care 
received by the mother contributed significantly to the prediction of 
infant development. The type of prenatal care accounted for 6 '.percent 
of the variance in mental development. The follow-up analysis of the 
pairwise comparisons of each type of prenatal care indicated significantly 
higher means for infants whose mothers received Teenage Pregnancy Team 
care when compared to those receiving treatment by a private physician 
and Shands Teaching Hospital High Risk Clinic. The results of the pairwise 
comparisons and the adjusted means for each prenatal care group are 
presented in Tables 17 and 18. As noted earlier, this question can only 
be answered with respect to the association between prenatal care and 
the dependent variables. The different types of prenatal care and their 



88 



Table 15 

Tests ox Significance of Contribution 
to the Prediction of Infant's Mental Development 



Regression 

Variable Coefficient F 



Mother's Age 


2.57 


6.92 


.01 


Baby's Sex 


-.92 


.04 


.84 


Baby's Birth Order 


-5. 85 


3.06 


.08 


Ethnic Origin 


.65 


.02 


.90 


Mother's Education 


-3. 50 




.07 


Yearly Income 


.76 


3.40 


,07 


Social Support System 


5.86 


2.88 


.09 


Prenatal Complication 


-13.16 


6.54 


.01 


Perinatal Risk 


.12 


.38 


.54 



89 



Table 16 

Test of Significance of Contribution of 
Continuous Variables to Prediction of Infant's 
Psychomotor Development 



Variable 


Regression 
Coefficients 


F 


P 


rio cner s Age 


1 . 09 


2.62 


.11 


Daoy s oex 


6 .67 


4.81 


.03 


Baby's Birth Order 


-4.50 


3.46 


.07 


Ethnic Origin 


-.83 


.06 


.81 


Mother's Education 


-1.00 


..S7 


.45 


Yearly Income 


.31 


1.21 


.28 


Social Support System 


1.14 


.23 


.63 


Prenatal Complications 


-5.60 


2.48 


.12 


Perinatal Risk 


.01 


.01 


.94 



90 



Table 17 



Pairwise Comparisons of Types of Prenatal 
Care as Predictors of Infant ' s^ Mental Development 



Pair Contrasted 



Difference 
Between 
Means T 





18 


.59 


1 


.83 


.07 


i^rivate i^nysici an- -Maternal Infant Care Proj . 


12 


.24 


1 


.28 


.21 


Private Physician--Teenage Pregnancy Team 


26 


.36 


2 


.68 


<.01 


Private Physician--S .T.H. High Risk Clinic 


2 


.14 




.23 


.82 


Public Health- -Maternal Infant Care Proj. 


6 


35 




87 


.39 


Public Health--Teenage Pregnancy Team 


7 


77 


1 


04 


.30 


Public Health--3.T.H. High Risk Clinic 


20 


73 


2 


49 


.02 


Maternal Infant Care Proj . --Teenage Preg. Team 


14. 


12 


2 . 


31 


.02 


Maternal Infant Care Proj . --S. T.H. High Risk 
Clinic 


14. 


38 


n 


10 


.04 


Teenage Pregnancy Team— S. T.H, High Risk Clinic 


28. 


51 


3 . 


94 


<.01 



91 



Table 18 

Mean Mental Development of Infants 
in Each Prenatal Care Group After 
Adjusting for Variance Explained by All 
Other Independent Variables 



Prenatal Care Group 

Teenage Pregnancy Team 

Public Health Department Clinics 

Maternal -Infant Care Clinics 

Private Physician 

S.T.H. High Risk Clinic 



140.03 
132.26 
125.91 
113.68 
111.52 



92 



educational programs are discussed in Chapter V. 

The data did not support the hy-pothesis that either perinatal risk 
status or the quantity of social support received by the mother was 
related to her transactions with her infant or the infant's development. 
In addition, it was found that no independent variables contributed 
to the prediction ox the mother-infant transaction process. 
The Prediction of Infant Development 
The second multivariate multiple regression analysis was imple- 
mented in order to ascertain the ability of the transaction components 
to predict infant development. This analysis was also directed to 
the questions regarding the mother's age and prenatal and perinatal 
variables as predictors of infant development when the variance 
explained by transaction was partialled out in the model. The second 
analysis was designed to answer the following questions: 

Question Three: ^A^hat is the nature of the relationship between 
prenatal medical care and development at six 
months after controlling for the age and 
education of the mother, the sex and birth order 
of the infant, ethnic origin, yearly income 
and perinatal risk? 
Question Four: raich variables contribute predictive information 
to the identification of developmental delays 
on infant development measures at six months? 
Question Eight: Is there a relationship between the age of the 
mother and infant development after controlling 
for transaction, infant sex and birth order, 



93 



mother's education, perinatal risk status, ethnic 
origin, yearly income, social support system and 
type of prenatal care and education? 
The questions were answered by the second multivariate multiple 
regression analysis. Mental and psychomotor development were regressed 
on mother's age and education, infant's sex and birth order, warmth, 
reciprocity, responsive vocalization, negative affect, nonresponsive 
stimulation, yearly income, ethnic origin, social support system, peri- 
natal risk status, prenatal complication and type of prenatal care. 
From the multivariate tests of significance (Table 19 j, it can be seen 
that the age of the mother, prenatal complications, responsive vocal- 
izations and t>'pe of prenatal care contributed to the overall prediction 
of infant development (a = ,05), 

The results of the univariate analyses are presented in Table 20. 
This represents the contributions of mental and psychomotor development 
and revealed that both models were significant. A visual inspection 
of the plots of the residuals indicated that the data met the assumption 
of horaoskedasticity and were appropriate for the analyses. 

The follow-up univariate analysis (a=,01) of mental development 
(Table 21) was consistent with the first analysis and indicated that 
the age of the m.other had a positive relationship to her infant's mental 
development. The plot of the residuals against m.other 's age evidenced 
no deviation from linearity. It was therefore concluded that there 
was a positive linear relationship between the age of the mother and 
her baby's mental developm.ent. Mother's age was found to explain 
10 percent of the variance in mental development. The regression 



94 



Table 19 

Results o£ the Multivariate Significance 
Tests of Contributions to the Infant's 
Mental and Psychomotor Developraent 



Variable 


F* 


df 


p.- 


Warmth 


2. 27 


2,57 


■ .11 


Reciprocity 


.53 


2,57 


. .59 


Responsive Vocalization 


3. 72 


2,57 


.03' 


Negative Affect 


.92 


2,57 


. .40 


Nonresponsive Stimulation 


1.17 


2,57 


,. . 32 


Mother's Age 


4.05 


2,57 


. .02" 


Baby's Birth Order 


2.66 


2,57 


. .08: 


Sex of Baby 


2.99 


2,57 


. .06. 


Ethnic Origin 


.17 


2,57 


. .84 


Mother's Education 


1.64 


2,57 


.20 


Yearly Income 


2.71 


^ 57 


. .08" 


Social Support System 


1. 19 


2,57 


. . 3-1 , 


Type of Prenatal Care 


3.46 


8,114 


.<.01 


Prenatal Complications 


4.05 


2,57 


. ■.0"2." 


Perinatal Risk Status 


1.12 


2,57 


. 33 



■^conversion of IVilks' Criterion to an F statistic 



95 



Table 20 

Tests of Significance of 
Contribution of Prediction for Both 
Dependent Variables Combined 



Variable 



Mental Development 
Psychomotor Development 



.45 
.40 



2.65 
2.10 



.002 
.017 



96 



Table 21 



Tests of Significance of Contribution of Continuous 
Variables to the Prediction of Infant's Mental Development 



Variable 


Regression 
Weights 




F 


P 


Warmth 


-.6764 


4 


.57 


. 04 


Reciprocity 


-.1079 




.85 


. 36 


Responsive Vocalization 


.5411 


3 


.06 


. 09 


Negative Affect 


-.4984 


1 


.00 




Nonresponsive Stimulation 


. 1331 




35 


. 72 


Mother's Age 


2.6173 


7 


67 


< . 01 


Birth Order 


-5. 8106 




22 


08 


Ethnicity 


- i . D^iU 


0 


10 


. 76 


Mother's Education 


-3.4221 


3. 


33 


.07 


Yearly Income 


.9624 


5 . 


46 


.02 


Sex 


.0772 




00 


.99 


Social Support System 


-5.050 


2 _ 


23 


.14 


Prenatal Complications 


-13.976 ■ 


7 _ 


96 


<.01 


Risk 


■-.292 


2. 


27 


.14 



97 



coefficients indicated that for each year of mother's age, the infants 
differed, on the average, by 2.6 points on the Mental Development Index 
and by 1.2 points on the Psychomotor Development Index. (Table 22). 

Question ten was concerned with the relationship between perinatal 
risk and development at six months. No significant association was 
found to exist between perinatal risk and either mental or psychomotor 
development . 

The presence of prenatal complications (anemia, toxemia, infection or 
venereal disease) was found to have a negative relationship with the 
infant's mental development and accounted for 12 percent of the variance. 
No deviations from linearity were evidenced on the plot of the residuals 
against prenatal complications; it was therefore concluded that there 
was a negative linear relationship between prenatal complications and 
mental development. No significant relationship between prenatal 
complications and psychomotor development was found. 

Responsive vocalization, the component which included the behaviors 
baby's vocalizations, mother's contingent vocalizations and baby's 
contingent vocalizations ,v/as found to have a positive relationship 
to the infant's psychomotor development and accounted for 11 percent 
of the variance. No significant relationship was found to exist between 
responsive vocalization and mental development. 

TTie type of prenatal care contributed to the prediction of 
both mental and psychomotor development. Pairwise comparisons of the 
four groups indicated that the means of those infants whose .mothers 
received treatment by a private physician scored significantly lower 
on both mental and psychomotor indices than those who received care 



98 



Table 22 

Tests of Significance of Contribution to the 
Prediction of Infant's Psychomotor Development 



Independent 

V CLJ. J-CLU ±C 


Regression 
weignts 


F 


P 


Warmth 


-.1668 


.58 


.45 


Reciprocity 


-.0695 


.73 


.40 


Responsive Vocalization 


.5752 


7.23 


<.01 


Negative Affect 


- .4418 


1.65 


.20 


Nonresponsive Stimulation 


.5898 


2.25 


.14 


Mother's Age 


1.2720 


5.78 


.06 


Baby's Birth Order 


-4.7877 


4.57 


.04 


Ethnicity 


-2.1277 


.35 


.55 


Mother's Education 


-1.1858 


.84 


. 36 


Yearly Income 


.3642 


1.63 


.21 


Baby's Sex 


-6. 7385 


4.77 


.03 


Social Support System 


.6892 


,09 


.77 


Prenatal Complications 


-6.0120 


3.08 


.08 


Risk 


.1037 


.60 


.44 



99 



from Maternal and Infant Care Clinics and the Teenage Pregnancy Team. 
Significant differences were also found to exist between Maternal and 
Infant Care Clinic patients and Shands Teaching Hospital High Risk 
Clinic patients. The mean of the Teenage Pregnancy Team infants was 
also significantly higher than the infants of Shands Teaching Hospital 
High Risk Clinic. The pairwise comparisons and the adjusted means are 
presented in Tables 23 and 24. 

It should be noted that a discrepancy exists between the results 
of the first and second analyses with regard to the significance of 
the type of prenatal care as it related to psychomotor development. An 
inspection of the adjusted means for each prenatal care group (Table 25) 
indicated large, but nonsignificant differences on the transaction 
components. This variance was not accounted for in the first analysis. 
In the second analysis, partialling out the variance explained by 
transaction yielded a significance association between the type of 
prenatal care and the psychomotor development of the infant. 
The Prediction of Developmental Delay 

The question regarding delays in infant development could not 
be answered due to the fact that no infants scored below 68 on either 
the mental or the psychomotor scale. As a result of this analysis, 
however, certain variables have been identified which do contribute 
to the prediction of developmental risk in infancy. The variables 
which were found to be associated with negative outcomes in mental 
development were: 1) the young age of the mother; and 2) the 
presence of complications during pregnancy. Negative outcomes in 
psychomotor development were associated with a lack of responsive 



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101 



Table 2,^ 



sans for Prenatal Care Groups after Adjusting for Variance Explained 
by Transaction Components and Ml Other Independent Variables 



Type of Prenatal Care 



Mental Develooment 



Psvchomotor DeveloDment 



Private Physician 
Public Health Department 
Maternal Infant Care Clinics 
Teenage Pregnancy Team 
Shands Teaching Hospital 



108.640 
132. 973 
126.882 
143.407 
110.742 



108.005 

120.406 

123.1183 

127.319 

109.319 



102 



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103 



vocalization in the sother- infant transaction process. It can be 
concluded that several of the variables contributed to the prediction 
of risk in infant development. 

Mother- Infant Transaction as a Predictor of Infant Development 

One of the fundamental questions investigated in this study 
concerned the relationship between mother- infant transaction and 
the mental and psychomotor development of the infant. The question 
addressed was: 

Question Nine: Are the transaction components of 

the mother-infant relationship--warmt?i, 
reciprocity, responsive vocalization, 
negative affect, and nonresponsive 
stimulation- -associated with the psycho- 
motor and mental development of the infant 
after controlling for mother's age and 
education, baby's sex and birth order, 
yearly income, ethnic origin, social 
support system, perinatal risk and type 
of prenatal care? 
The preceding analysis was conducted to test the hypothesis 
that the transaction components predicted mental and psychomotor 
development in infancy when all other variables were held constant. 
The analysis involved testing the hypothesis for each dependent 
variable separarely. The F statistics for mental and psychomotor 
development were 2.34 and 3.36, respectively and were computed in the 



104 



following manner: 

F = [Sum of Squares (Full Model)-Sum of Squares" (Reduced Model)1/5 

Mean Square Error (Full Model) 

Mental 

Development F = [4807.1218 - 2669.8295] / 5 

126.9130 

= 2.34 

Psychomotor 

Development F = [12660.4948 - 9552.8869]/ 5 

265.0281 

= 3.36 

The critical value is F (5 ^61,. 025)= 2.74. It was therefore 
concluded that the shared variance of the mother-infant transactions 
components- -warmth, reciprocity, responsive vocalization, negative 
affect and nonresponsive stimulation--contributed to the prediction 
of the infant's psychomotor development, but did not contribute 
to the prediction of the infant's mental development. 

Followup tests (Tables 21 and 22} supported only the h>'pothesis 
that the unique proportion of variance accounted for by responsive 
vocalization contributed to the prediction of psychomotor development. 
Responsive vocalization accounted for 11 percent of the variance 
in psychomotor development. Based on the positive regression 
weight, it can be concluded that there is a positive relationship 
between responsive vocalization and the infant's psychomotor development. 
An examination of the residual plots indicated that the relationship 
between the two variables was linear. 

Sumraary 

The analyses presented in this chapter were designed to ascertain 
the strength and nature of the relationships of the age of the mother. 



105 



prenatal, and perinatal factors, and socioenvironraental , medical 

and educational resources to mother- infant transaction and infant 

development in an age- specific sample. In the first analysis, the 

measures of transaction and development were considered to be 

outcome measures of early pregnancy and parenting. Mental development was 

found to be associated with the age of the mother, the type of 

prenatal care received by the mother and prenatal complications. 

No variables were found to contribute to the prediction of 

infant's psychomotor development and the mother-infant transaction 

process . 

The second analysis was concerned with the prediction of the 
developmental outcomes of the infant. Several variables were found 
to be associated with the infant's development. The variables which 
were identified as predictors of mental development were: 1) the 
age of the mother; 2) the type of prenatal care received by the 
mother; and 3) the presence of prenatal complications. Psychomotor 
development was found to vary as a function of: 1} responsive 
vocalization of the mother-infant transaction process; and 2") 
the type of prenatal care received by the mother. 

The dimensions of mother-infant transaction were found to 
contribute a significant proportion of shared variance to the 
infant's psychomotor development. The component of transaction 
which contributed a uniquely significant proportion was responsive 
vocalization. The results of the study and their implications 
for future research and intervention are discussed in Chapter V. 



CHAPTER V 
DISCUSSION AND IMPLICATIONS 



In this study, the most important questions were concerned 
with the multidimensional outcomes of early pregnancy and parenting. 
The study was designed to explore the relationship of the age of 
the mother, prenatal and perinatal factors and socioenvironmental, 
medical and educational resources to the dimensions of mother- 
infant transaction and the development of the infant. This 
research reflects an effort to enhance our understanding of 
the young mother and her infant and, as a result, design more appro- 
priate and comprehensive support services to the young family. 
The findings of the study and their implications are discussed 
in this chapter. 

The Age of the Mother as a Predictor of Infant Developme nt 
and Mother- Infant Transact ion ' 

The most important questions posed in Chapter I asked "what 
are the behavioral characteristics of the very young mother? 
how does she relate to her baby and what is the association between 
her style of mothering and her baby's development?" The questions 
addressed several dimensions of early family development. 

In the first analysis, which viewed transaction and development 
as outcome measures, no variability in mother-infant transaction 
was found to be related to mother's a^-e. 



106 



107 



The age of the mother did, however, contribute to the prediction 
of her baby's mental development wherx transaction was considered 
as a dependent variable. The age of the mother was also associated 
with her baby's mental development when the proportion of variance 
accounted for by mother-infant transaction was held constant. The 
data suggested that the infants of younger mothers were less competent 
on a measure of mental development and that, as mother's age increased, 
so did the infant's mental development. 

The problem of multicolinearity could not be dealt with 
adequately in this study due to the need for an extreme large data set. 
It is therefore difficult to tease out the unique contributions of 
mother's age and education, ethnic origin, birth order, yearly income 
and prenatal complications. For instance, it remains unknovm whether 
the infant's development is threatened by the fact that the mother is 
young or if development is threatened by the mother who is prone to 
problematic pregnancy due to poor nutrition (anemia and toxemia], 
infection and venereal disease. Specifically, are mothers who are 
more likely to have complications during pregnancy and have fewer 
material resources also less able to stimulate the mental development 
of the infant? 

The significa7ice of the association found between mother's age 
and the infant's mental development is in accord with other research 
concerned with the infants of adolescent mothers (Hardy et al . , 1978). 
The implications of ihe present findings indicate a need for early and 
intense developmental and educational intervention protocols which are 
designed to enhance the competence of the infants of young mothers in 
order to prevent long term handicapping conditions. 



108 



The findings of this and other studies (Clarke-Stewart, 1973; 
Beckwith et al., 1975) have documented the potential of the transac- 
tion process to enhance infant development. We therefore have support 
for the concept of parent a.nd infant-centered approaches to early 
intervention. The findings of this study also suggest that the 
dimensions of mother-infant transaction generalize across the age of 
the mother and that the young mother is as adept in her ability to 
facilitate positive transaction whth her infant as her "of age" peer. 
The strength of the mother-infant relationship is perhaps one that is 
able to be focused on in our attempts to help mothers enhance their 
infant's mental competencies. As professionals, there is often little 
we can do to modify the immediate socioenvironmental variables and 
biological threats due to prenatal complication that relate to infant 
development. We can, however, support young mothers in their 
transition to parenthood and their development of a transactional reper- 
toire which is responsive to the infant and thus facilitative of their 
babies' development. 

Prenatal and Perinatal Factors and Socioenvironmental, Medical and 
Educational Resources as Predictors of Mother-Infant Transaction and 

Infant Development 

Previous research regarding early parenting revealed the mother's 
social support system and the professional services she receives to 
have a relationship both to her development as a mother and her 
infant's competence (Furstenburg, 1973; Kotelchuck, 1979; Brazelton and 
Lester, iNote 1; Dott and Fort, 1978). These questions 



109 



were investigated in this study, as well. The data indicated no 
significant relationship between the quantity of social support 
and development and transaction. This was surprising and suggests 
that perhaps the basis upon which support was quantified- -cohabitati 
income and childcare assistance- -was not an appropriate measure of 
the qualitative aspects of support which have been associated with 
family development. An additional instrument to assess the qualita- 
tive characteristics of the mother's social support system would 
assist in future studies. 

The findings indicated the positive association between more 
comprehensive models of prenatal care and the mental and psycho- 
motor competence of the infants. The most significant differences 
in infants' mental and psychomotor development were found to exist 
between prenatal care which offered only obstetric services and those 
which included either an optional or a mandatory prenatal and 
childbirth education program. The highest means on infant develop- 
ment were found to be those of infants whose mothers received care 
in the model which included prenatal and postpartum parenting 
education as well as social service referral, nutritional and 
short term crisis counseling (Mahan, Note 2) . 

In interpreting this finding, it is important to note 
that a considerably larger proportion of the invited sample of the 
Private Physician care group patients participated in this study 
than those who received other ty^es of care. This suggests that the 
measures reflect those of more motivated mothers in the other 



110 



four groups J whereas the measures taken on private patients reflect 
a more random selection. Another consideration to be taken into account 
is the fact that subjects vere self-selected into each type of 
prenatal care group on the basis of socioeconomic status and geo- 
graphic location. Consideration of these results should also 
be based on the fact that the design of the study was retrospective 
and as such, no causal inferences with respect to differences between 
groups can be made. No outcomes can be said to be associated with 
the prenatal or parenting education components of the models due 
to the fact that these variables were excluded from the analyses. 
These results do, however, suggest a need for more controlled -ex- 
perimental designs which would permit the investigation of the 
effects of interdisciplinary service models on the parent-infant 
relationship and infant development. 
The Prediction of Developmental Risk in Infancy 

The results of this study indicated that the young age of 
the mother, the presence of prenatal complications and a lack of 
responsive vocalizations in the mother-infant transaction process 
are associated with negative outcomes in infant development. It 
was surprising that no infants in this sample (which consisted of 
many low income and/or adolescent mothers) scored at or below 63 
(the clinical criterion for delay] on the Bayley Scales of Infant 
Development . Several possible explanations of this deserve mention. 
One possible cause is that the examiner "tested high." This 
consideration, as ivell as the fact that the infants participated 
in 15 minutes of free play prior to the assessment, may well have 



Ill 



Influenced the infant's level of optimal performance which was 
stated to be a goal of the assessment (Bavley, 1969). A third 
consideration is the small niuBber (20 of 250) of high risk 
infants (those who were bom prematurely or had neonatal complications) 
who were selected at random as part of the invited sample. Of the 
20 high risk infants sampled, four participated in this study. 
The data were unable to answer the question and the identification 
of delay in an age specific sample thus remains in need of future 
investigation. 

Of benefit to our knowledge base would be the longitudinal 
assessment of the infants of adolescent parents. That these infants 
are at risk has been well documented in the literature. The findings 
presented in this study indicated that differences exist as early as 
six months of age. It is the subjective opinion of the author 
that a major factor in the success of patient follow-up lies in the 
direct communication by telephone to advise them of services offered 
to the family. In explaining the procedures carefully, questions 
may be answered and parents m.ay be made to feel that they were 
"lucky" to be chosen. This approach was used successfully in a 
seven year follow-up of the Collaborative Perinatal Study (Dallas, 1971). 

A more thorough assessment battery for long term follcw-up 
i,vould be an asset as well. The use of the Behavior Profile in the 
Sayle y Scales of Infant Development and its relationship to mother- 
infant transaction is another unexplored area of early parenting. 
The addition of an instriiment to assess qualitative characteristics 



112 



of social support would contribute to future investigations and 
yield valuable information. 

An analysis of the subscales (language, social, cognitive and 
gross and fine motor skills) of the mental and psychomotor scales 
would be of assistance in order to make early developmental inter- 
vention more appropriate for each individual infant and family. 
Mother- Infant Transaction as a Predictor of Infant Development 

The relationship between mother- infant transaction and 
infant development was one of the most important questions in this 
study. The findings revealed responsive vocalization to be positively 
related to the infant's psychomotor development. The shared 
contribution of the mother-infant transaction components was also 
found to be related to the infant's psychomotor development. 

The results of this study support the idea that the mother- 
infant relationship is important to the infant's development of 
competence. We also have reason to believe that more comprehensive 
interdisciplinary models of prenatal and perinatal support are 
associated with enhanced development of the infant. These findings 
suggest several considerations in the design of parent and infant- 
centered interventions for the young parent family. There is reason 
to believe that early and prolonged intervention with young parents 
and their infants can enrich the quality of care and stimulation 
provided by the mother and thus enhance the development of her infant. 



113 



Suinmary and Conclusions 

The findings discussed in this study indicate that there is 
a need to reach both parent and child at the earliest possible 
moment and in a most comprehensive approach, for in this way, 
individuals will be given the opportunity to develop to their 
maximum potential. Meeting the special needs of the young parent 
family presents a multifaceted challenge to efforts on the part 
of the professional coramuntiy. 

Although the findings of this study do not indicate the 
extended family to be of importance, a special concern with the 
adolescent mother is that our efforts must be focused toward not only the 
young mother, but the father of her baby and the members of their 
extended families, as well. This was acknowledged in the studies 
of Furstenberg (1976, 1978) and Kotelchuck . (1979) . Often tills will 
mean extensive coordination of all phases of the clinic, school and 
home-based programs. In this way, the quality of care provided 
m.ay become more truly comprehensive in nature. 

At the heart of this approach is the primary prevention of 
early pregnancy--both repeat and first pregnancies--to individuals 
who are unprepared for the tasks of parenthood. With the extension 
of confidential family planning services and curricula designed to 
deal with the issues of hu.nmn sexuality and family development, 
ix is anticipated that young people will become more responsible 
in their sexual activities. 

Our purpose here was to explore the role of the adolescent as 
a mother and her baby's development. As noted earlier, the philosophical 



114 



basis of this study was a strong belief in the positive characteristics 
of the young parent --courage, enthusiasm, adaptability and, above all, 
an optimistic view of the future. It is hoped that the results of this 
study and the literature presented herein will allow our future efforts 
to focus on the qualities of the mother-infant relationship in order 
to enhance the development of the infant and strengthen the family. 

It is important to remember that these young women have chosen to 
continue their pregnancies and undertake the tasks of motherhood. 
Remember, too, that most individuals, regardless of age, come to parent- 
hood relatively unprepared for the responsibilities of caring for and 
nurturing another human life. The positive grovrth and development of 
these young parents and their children is dependent upon cur interdis- 
ciplinary efforts to support them in a comprehensive manner as they grow 
together as a family. 



APPENDIX A 
PARENT CONSENT FORM 



The first months of life are important as families grow. For 
this reason, we would like your permission to study how your baby's 
body and mind are developing. The study involves making a videotape 
(like a television film) of you and your baby playing and using the 
Bayley Scales of Infant Development to study your baby's mental and 
physical abilities. We will be happy to answer any questions before, 
during or after the study. You will be informed of the results of 
the study and will be sent a photograph of you and your baby and a 
book of baby exercises, games and learning activities. 

We are looking forward to working with you and your family and 
hope you will agree to be a part of our study. If you will agree to 
participate, please sign below. 

In the event of sustaining a physical injury which is proximately 
caused by this experiment, professional medical care will be provided 
for me at the J. Hillis Miller Health Center. There will be no charge 
to me, exclusive of hospital expenses. 

, have read and under- 
stood the informed consent statement and give my permission for studying 
my child and using the information and videotapes for research and 
teaching purposes. I also realize that I may change my mind and 
withdraw my permission at any time. 

Witness Signed 

Witness Relationship 

to Child 



116 



Name 
Address 



Telephone 

Six Month Assessment 
Child and Family Development Evaluation 
Julie Hoflieimer 
Departments of Obstetrics and Gynecology and 
Pediatrics 

^Release Form 

Parent's Questionnaire 

Bayley Scales of Mental and Motor Development 

Videotaped Free-Play 

^Hobel Assessment of Perinatal Risk 



Evaluation Protocol 

Mothers will be notified of their appointment by mail one month 
prior to test date. They will be mailed the reminder postcard one week 
prior to testing and phoned to confirm the' appointment two to three 
days prior to testing. 

Upon arrival in the Pediatric Clinic, they will be brought into the 
Developmental Clinic Playroom and the Assessment Specialist will explain 
the procedure for the freeplay videotape and Bayley Scales of Infant 
Development. Upon agreeing to participate in the study, the mother will 
be asked to sign the consent form. 

The freeplay situation will be videotaped and the developmental 
assessment administered. Tlie Developmental Specialist will then take 
the family into the waiting room and explain the results of the assess- 
ment, show the mother learning activities: which are keyed into the 



117 

infant's developmental strengths and weaknesses, and give the mother 
illustrated descriptions of the activities demonstrated. Following 
the assessment, mothers will be interviewed to obtain demographic 
information. 



118 



Child and Family Development Questionnaire 
Six Month Evaluation 
Julie Hofheimer 



1. 


Hospital Number 


5. 


Mother 


s Name 


2. 


Date 


6. 


Mother 


s DOB 


5. 


Baby's Birth Condition 


7. 


Baby ' s 


Nam.e 


4. 


Baby's Birth Order 


8. 


Baby ' s 


DOB 



10. 



11, 



10. 



14, 



What is your ethnic origin? 

^White Am. ^Puerto Rican European Other 

Black Am. 



Am. Indian 



Asian 



East Indian 



Cuban 



Mexican 



Please 
State 



What is your baby's father's ethnic origin? 
Are you ^married ^Single M 



living 
with baby's 
father 



living 

with 

husband 



living with 1 or both 
F parents 



living with 
_relative 

living with 
friend 



With whom do you share a home? 
(Check all that apply) 



Mate or 
Husba.nd 



Father 



Mother 



Sister (s) 



brother (s) 
children 



live alone 



friend (s) 



with baby 

iWho helps care for your baby? 



uncle (s) 



grandparent (s) 



aunt (sj 
in home 



childcare 
center 



friend 



^relative 

In what type of residence do you live? home 
campus 



ar>t . 



trailer 



rooming 



housing house 
Kow much school have you completed? Please circle highest level. 



1 



vocational 



Degree 



_:3 D /_ 

College 
Grad. 



10 



attended Jr. College 

12 Jr. College Degree 



Master':s Doctoral or 



'egree 



Prof, 



uegree 



119 

How much school did your baby's father complete? 



15. Are you still in school? ^Yes T^yv^ 



16, What is your total yearly income? $1,000 ^$2,000 $3,000 



_$4,000 ^$5,000 ^$6,000 ^$7,000 ^$8,000 ^$9,000 

_$10,000 ^$11,000 ^$12,000 ^$13,000 ^$14-16,000 



$16-18,000 ^$18-20,000 ^$20,25,000 ^$25-30,000 



$30-40,000 



mate or 

17. What are your income sources? self-employment husband's employ. 

food baby's father's 
AFDC ^!VIC ^stamps your parents /family family 



private public health 

18. Where did you receive prenatal care? physician clinic (please 

(Please indicate frequency) name) 

^MIC Clinic ^STH OB Clinic APT Clinic 

public 

19. Where does your baby receive health care? private health 



MIC/PEDS Clinic SlTi FEDS Clinic 



20. Have your participated in any Parenting Education or Support Program? 
prenatal ed. class APT Clinic 



childbirth ed. class friends 



psychologist or child development ^relative 



books, TV, newspapers ^church 

home, economist/social ser\ace ^community ed. 



Where was this program located? 
How often did you participate? 



APPENDIX B 



DEFINITIONS OF MOTHER MD INFANT BEHAVIORS 

Adapted Beckwith Behavior Scale 
Maternal Behaviors 

1. Comments : positive verbalizations; all positive vocalizations 
.•-including questions, praises, suggests, focuses verbally. 

2. Commands : mother-oriented, directive and forceful verbalizations; 
clear imperative to initiate action. 

3. Criticism : clear request to terminate action or verbalizations 
which are critical or hostile or derogatory. 

4. Nonverbal bids : positive touch, help, facilitate, provide. 

5. Initiating behaviors : self-oriented maternal behavior; 
getting baby's attention in some nonverbal way, actions which 
direct baby in a different direction rather than extending 
baby's behavior. 

6. Repetitive nonverbal bids : repeating the same or simi la- 
bids over and over for several 15-second period. This has 
a monotonous quality, such as presenting different toys 
one after the other in a very similar manner. 

7. Staccato bursts : rapid bursts of maternal behavior which 
allow little or no time for infant response. 

8. Affectionate touch : kiss, pat, hug, nuzzle, etc, 

9. Interfering touch : mother touches baby to distract, inhibit 
oi^-going ..activity. Includes hitting, moving object from hands, 
pulling back, etc. 

12D 



121 

10. Repetitive verbalizations: brief phrases repeated over and over 
for most of a 15-second period. 

Infant Behaviors 

11. Bid to caregive r: request for help; reach, point, or share; 
positive gestures- 

12. Vocalization : nondistress vocalization, babbling, gurgling, 
cooing. 

13. Smiles at mother : not frowning, not grimacing., 

14. Self- stimulatory behavior : thumb sucking, extended rocking or 
other non-task-oriented or exploratory behavior. 

15. Vacant behavior : empty or blank or facial expression; baby 
is not interacting with caregiver or environment. 

16. Explores : curious visual or manual exploration of environment. 

17. Fusses: crying or fussing; not contingent on mother behavior. 
Reciprocal Behaviors 

18. Maternal positive responding : caregiver responds to infant 
positive bid or distress in a positive manner by permitting, 
giving, engaging, helping, accepting, etc. Does not include 
imitates, elaborates, or amplifies baby's vocalizations or 
behaviors . 

19.. Maternal negative responses : ignoring or rejecting baby's 

social bid or on-going activity either verbally or nonverbally. 
Examples: not returning a toy that rolls away from infant, 
turning away, or stopping a baby's initiations. 

20. Ma ternal ignoring : mother ignores bids or activity of baby. 

21. Baby positive respondin g: baby responds to mother's bid 
positively by smiling, reaching, pointing, vocalizing, etc. 



122 



22. Baby's negative responding : baby responds to mother's bid 
by fussing, crying, turning away, etc. 

23. Baby ignoring : ignores bids or activity of mother. 

24. Face- to- face orientation : mother is in a position facing 
baby. 

25. Mutual gaze : the two faces are in the same vertical and 
horizontal plane. 

26. Mother's contingent verbalization to infant vocalization : 
mother either imitates or responds vocally to nondistress 
vocalization by infant. 

27. Baby's contingent vocalization : baby either imitates or 
responds vocally to mother's behavior. 



APPENDIX C 



BAYLEY SCALES OF INF.aj^IT DEVELOPMENT 
A. Psychomotor Index 

Item Age Range Item Presentation 

21 4.9 Cube: partial thumb opposition (radial -palmer) . 

With the child seated at the table, place a 1-inch 
cube within his easy reach. Also credit i£ he 
passes item 32. 

Credit: at this level if the child picks up the 
cube with his thumb partially pooposed to his 
fingers, using the palm as well as the thumb and 
fingers . 

22 5.3 Pulls to sitting position. Stand at the foot of 

the crib and lean over the child whil he is lying 
on his back. Give him your thumbs to grasp. With 
this support, allow him to pull himself to a sitting 
position and, if he is able, to a full standing 
position (item 36} . Gradually raise your hands as 
the child pulls, but take care not to do the pulling 



Credit: if the child pulls himself to a sitting 
position with the support of your thumbs. 

23 5.3 Sits alone momentarily. Administer as in item 17. 

Credit: at this level if the child sits momentarily 
without 37ipport . 

24 5.4 Unilateral reaching. 

Credit: if the child tends to reach with one hand 
more often than bimanually (with both hands at once) . 
The hand used need not be consistently either the 
right or the left. 

25 5.6 Attempts to secure pellet. Place a sugar pellet on 

the table within easy reach of the child. Observe 
his efforts to pick up the pellet. If necessary, 
attract his attention to it by motions of the hand, 
by tapping the table near the pellet, or by making 
it rock (as in Mental Scale item 52). 

Credit: at this level if the child makes an effort to 
pick up the pellet, whether successful or not. 



123 



124 



26 5.7 Rotates wrist. 

Credit: if the child rotates his wrist freely in 
manipulating toys (cube, rattle, bell), 

2" 6.0 Sits alone 30 seconds or more. Administer as in 

item 17. 

Credit: at this level is the child sits alone 30 
seconds or more. Note for item 29 whether the 
child's back is curved as he leans forward for 
support . 

28 6.4 Rolls from back to stomach. Administer as in item 19. 

Credit: if, under this or any similar situation 
during the examination period, the child rolls 
from his back onto his stomach. 

29 6.6 Sits alone, steadily. Administer as in item 17. 

Credit: at this level is the child sits alone 
steadily without support and v;ith his back fairly 
straight. 

30 6.8 Scoops pellet. Administer as in item 25. 

Credit: at this level if the child secures the 
pellet with a raking or scooping palmar prehension. 
Also credit if he passes item 35 or 41. 

6-9 Sits alone, good coordination. Administer as in item 17. 

Credit: at this level if the child sits alone 
steadily while manipulating toys, turning, or engaging 
in other actions that take his attention away from 

Mental Index "^"^^^ P^^'^^^^ 

5.5 Transfers object hand to hand. During the child's 

play with the rattle, ring, or other object, observe 
whether he changes the object from one hand to the 
other. 

Credit: if the child transfers an object from one 
hand to the other 2 or more times. Do not credit 
if this occurs only when the free hand comes into 
contact with the object by chance. 

70 5.7 Picks up cube deftly and directly. Place a cube on 

the table within easy reach of the child. Observe 
the manner in which the child picks up the cube. 
(Motor Scale items 16, 21, 32 may also be presented 
at this time.) 

Credit: if the child picks up the cube deftly and directl 



31 



69 



125 



71 5.7 Pulls string: secures ring. Administer as in item 67 

Credit: if the child secures the ring as the result 
of his own efforts, even though there is no evidence 
of purposive use of the string. 

''^ 5.8 Interest in sound production. Observe whether the 

child intentionally uses objects to make noise. 

Credit: if the child shows interest in producing 
sound as such, by banging t03^s , ringing the bell, etc. 

''^ 5.8 Lifts cup with handle. Administer as in item 63. 

Credit: if the child lifts the cup by the handle, 
using one hand predominantly. 

5,8 Attends to scribbling. Place a piece of paper on 

the table in front of the child; then place a 
crayon on the paper with the tip pointing away from 
him,. If he makes no effort tctouch the crayon to 
the paper, take the crayon and scribble plainly with 
obvious writing gestures. Then give the crayon to 
the child with directions (by word and gesture) to 
write. (See also item 95.) 

Credit: if the child attends to the demonstrated 
scribbling. 

''^ 6.0 Looks for fallen spoon. Administer as in item 62. ' 

(Note that items 62 and 75, involving both vision 
and hearing, are easier than items 86, 38, 91, 
and 96, which test "object constancy" by vision 
only.) 



76 6,2 



77 



Credit: if the child definately looks for the fallen 
spoon by turning and looking to the floor. 

Playful response to mirror. Administer as in item 53, 

Credit: if the child plays with the mirror image, 
with such responses as laughing, patting, banging, 
playful reaching, leaning toward the image, "mouthing" 
the mirror, etc. 

Retains 2 of 3 cubes offered. One at a time, place 3 
cubes on the table before the child, allowing him to 
pick up each one before the next is offered. Observe 
his behavior when he has a cube in each hand and 
the third cube is presented. 

Credit: if the child retains the first 2 cubes after 
the third is offered. (Often a child fails this by 
dropping a cube to reach for the third.) 



APPENDIX D 
PERINATAL RISK SCREENING 
Calvin Hobel (UCLA) 



Baby's Name Hospital # Risk Score 



I. 


Prenatal Factors 










1. 


Toxemia (moderate to severe) 


10 


13. 


Age ^ 35 or £ 1 5 


5 




Clironic hypertension 


10 


14, 


Viral disease 


5 


3. 


Mod-severe renal disease 


10 


15. 


Anemia 


5 


4. 


Eclampsia 


10 


16. 


Excessive drug use 


5 


5 . 


Diabetes 


10 


17. 


TB history 


5 


6. 


Rh exchange 


10 


18. 


Wt 100 or 200 


5 




Uterine malformation 


10 


19. 


Pulffionar>' disease 




8. 


Incompetent cervix 


10 


20. 


Flu s}rn,drome 


5 


9. 


Abnorm.al fetal position 


10 


21. 


Smoking 1 pack/day 


1 


10. 


Small pelvis 


5 


22. 


AJhilcohol '[ 


1 


11. 


Abnormal cervical cytology 


10 


23. 


Emotional problem 


1 


12. 


Multiple pregnancy 


10 


24. 


Infection 


1 








25 . 


Severs heart disease 


10 



126 



127 



II. Maternal Factors 



2. 
3. 
4. 
5, 
6. 
7. 



9. 
10, 



Moderate- severe toxemia 
Cpreeclampsia) 

Hydraranios/oligohydr amnios 

Amnionitis 

Uterine rupture 

Mild toxemia 

PROM 12 hrs. 

Primary dysfunctional 
labor 

Secondary arrest of 
dilation 

Demerol 300 mg. 
MgSo4 25 gm.. 



10 

10 
10 
10 
5 



11. Second state 2-1/2 
hours 

12. Labor > 20 hours 5 
15. Clinical small pelvis 5 

14. Medical induction 5 

15. Precipitous labor 5 
< 3 hours 

16. Primary cesarean 
section 

17. Repeat cesarean 
section 

18. Elective induction 

19. Prolonged latent phase 

20. Uterine tetany 1 

21. Pitocin augmentation 1 



III. Placental Factors 



3. 
4. 



Placenta previa 

Abruptio placentae 

Postterm;42 weeks 

Meconium stained amni- 
otic fluid (dark) 



10 
10 
10 
10 



4. Meconium stained 

amniotic fluid (light) 

6, Marginal separation 



12-8 



1 



IV. 


Fetal Factors 












1 

X. m 


Abnormal presentation 


10 


8 


Fetal tachycardia 


10 


2. 


Multiple pregnancy 




10 




30 min. 




3. 


Fetal bradycardia 
30 min. 




10 


9 


Operative forceps or 
vacuum extraction 


5 


4 . 


Breech delivery 
total extraction 






10 


Breech delivery spon- 
taneous or assisted 


5 


5. 


Prolapsed cord 




10 


11 


General anesthesia 


5 


6. 


Fetal weight < 2500 


gms . 


iu 


12 


Outlet forceps 


1 


7. 


Fetal acidosis pH > 


7.25 


10 


15 

1 A 

14 


Shoulder dystocia 
retal distress 


1 
10 


V. 


Neonatal Factors 












A. 


General 






B. 


Respiratory 




1. 


1000 grains 




15 


1 . 


RDS 


10 


2. 


Apgar 5m = < 5 




10 


2. 


Meconium aspiration 


10 


3. 


Resusciation 




10 


3. 


Congenital pneumonia 


10 


4. 


1000-1500 grams 




10 


4. 


Anomalies of respira- 


10 


5. 


Fetal anomalies 




10 




tory system 




6 . 


1500-2000 grams 




5 


5. 


Apnea 


10 


7 _ 


Dysraaturity 




5 


6. 


Transient tachypnea 


5 


8. 


Apgar Im = < 5 




5 


C. 


Metabolic Disorders 




9. 


Feeding problem 




1 


1. 


Hypoglycemia 


10 


0. 


Multiple birth 




1 


2. 


Hypocalcemia 


10 


1. 


2 000- 25 OQ grams 


! 


1 


^ 

4. 
5 . 
6. 


IIypo/h>'permagnesefflia 
Hypoparathyroidism 
Failure to gain weight 
Jitteriness 


5 
5 
1 

1 



129 



D. Cardiac 

1. Major Cardiac Anomalies IQ 

2. CHF 10 

3. Persistent cyanosis 5 

4. Major cardiac Anomolies 5 
without catheterization 

5 . Murmur 5 

E. Hematologic Problems 

1. H>'perbilirubinemia, 15 10 

2. Hemorrhagic diathesis 10 

3. Chromosomal anomolies 10 

4. Sepsis 10 

5. Anemia 5 

F. Central Nervous System 

1. CNS depression > 24 hours 10 

2. Seizures 10 

3. CNS depression < 24 hours 5 



REFERENCE NOTES 



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assessment. Personal communication, 1979. 
Mahan, Charles S. Teenage pregnancy team project grant 
proposal (DHEW-NIH), 1978. 

Mahan, Charles S, and Eitzman, D. V. North Central Florida 
maternity and infant care project grant proposal (DHEW-PHS), 
1978. 



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13S 



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B:IOGRAPHieAL SKETCH 



Julie Anne Hofheimer was born in Jacksonville, Florida, in 1952. 
Together with her parents, Anne and Norman, and younger brothers, 
Andy and Gary, she resided in Jacksonville as well as Long Island, New 
York, and Newton, Massachusetts. She received her B.S. in elementary 
and early childhood education from Florida State University in 1973 
and her M.Ed, in early childhood and elementary education from the 
University of North Florida in 1975. 

Julie taught first grade and kindergarten in Orange Park and 
Jacksonville. She also taught early childhood curriculum at the University 
of North Florida as an adjunct instructor in the Department of Elementary 
and Secondary Education. 

Upon beginning her doctoral program, Julie was a seminar leader in 
the Childhood Education Program at the University of Florida. From 
September 1978 until June 1979, Julie served as Infant and Family 
Development Specialist on the Adolescent Pregnancy Team in the Department 
of Obstetrics and Gynecology. During this time she also worked as a 
graduate research assistant in infant development for the Department or 
Pediatrics, Division of Neonatology. Tliroughout the year, Julie taught 
and supervised graduate students in Early Childhood and Family Development 
Education in the Department of Early Childhood Education. 

Plans for her future remain tentative, but Julie's professional goals 
include the continuation of research, teaching, and clinical experiences 
with youiig children and their families. 



140 



I certify that I have read this study and that in my opinion 
it conforms to acceptable standards of scholarly presentation and 
is fully adequate, in scope and quality, as a dissertation for the 
degree of Doctor of Philosophy. 



Athol B. Packer, Chairperson 
Associate Professor of 
Curriculum and Instruction 

I certify that I have read this study and that in my opinion 
it conforms to acceptable standards of scholarly presentation and 
is fully adequate, in scope and quality, as a dissertation for the 
degree of Doctor of Philosophy. 



James J. Algina 
Assistant Professor of 
Foundations of Education 

I certify that I have read this study and that in my opinion 
it conforms to acceptable standards of scholarly presentation and 
is fully adequate, in scope and quality, as a dissertation for the 
degree of Doctor of Philosophy. 




Patricia T. Ashtcto 
Assistant Professor of 
Foimdations of Education 



I certify that I have read this study and that in my opinion 
it conforms to acceptable standards of scholarly presentation and 
is fully adequate, in scope and quality, as a dissertation for the 
degree of Doctor of Philosophy, 



I certify that I have read this study and that in my opinion 
it conforms to acceptable standards of scholarly presentation and 
is fully adequate, in scope and quality, as a dissertation for the 
degree of Doctor of Philosophy. 



This dissertation was submitted to the Graduate Faculty of the 
Department of Curriculum and Instruction in the College of Education 
and to the Graduate Council, and was accepted as partial fulfillment 
of the requirements for the degree of Doctor of Philosophy. 

August, 1979 




Michael B. Resnick 
Assistant Professor of 
Pediatrics 




./ 



Robert S. Soar 
Professor of 
Foundations of Education 



Dean, Graduate School 



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